Psychophysiological evidence for cortisol-induced reduction in early bias for implicit social threat in social phobia

Cross-cultural validation of the BFOE model: Best practices and future directions for psychometric evaluation of the Fear of positive evaluation scale - Insights from a Dutch translation

The Bivalent Fear of Evaluation (BFOE) model suggests that Social Anxiety Disorder is not only characterized by fear of negative evaluation (FNE), but also fear of positive evaluation (FPE). While FNE has been firmly established, research of the latter is accumulating. To evaluate the role of the BFOE Model, and particularly FPE, validated measures such as the Fear of Positive Evaluation Scale (FPES) are pivotal. Yet, validation of psychometric properties is often at stake or neglected when translating a scale to other languages. This hampers cross-cultural evaluation of questionnaires and related concepts considerably, including the BFOE Model. To illustrate, a freely available, but not validated Dutch version of the FPES was completed, along with other measures by 354 community participants from the Netherlands and Belgium in an online study. The Dutch FPES showed excellent convergent and discriminant validity. In addition, it explained additional variance in social anxiety above and beyond FNE. These results as well as those from the factor analyses were highly comparable with those deriving from evaluations of the original English version. In conclusion, the Dutch FPES showed excellent psychometric properties and is fit for further exploring consistency or differences in the BFOE model across cultures. Based on this case, practice guidelines for international use and validation of measures are discussed, and recommendations are provided.

Differences in attentional bias between self-related information and external cues from others in individuals with social anxiety: An event-related potential study

Individuals with high social anxiety show a more considerable attentional bias toward self-relevant information and outwardly threatening stimuli than do those with low social anxiety. Some studies have investigated the attentional bias between self-relevant information and external social cues in people with high social anxiety but have not reached consistent conclusions. This study used a modified dot-probe task and collected temporal and electroencephalogram responses to three self-other face pairs among 15 people with high social anxiety and 20 people with low social anxiety. Both groups responded quicker to self-relevant information than external social cues. Others' emotional potencies moderated the attentional bias. Individuals with high social anxiety exhibited larger P1 amplitudes and smaller N170 amplitudes (mainly in the right hemisphere) for all face pairs and larger P2 amplitudes for the self-neutral and other-angry face pairs than those with low social anxiety. These findings suggest that people with social anxiety prioritize allocating attentional resources to self-relevant information, with others' angry faces having the greatest influence on the allocation. Individuals with high social anxiety initially exhibit more attentional vigilance and less structural coding for face pairs, followed by heightened engagement with threatening cues compared to those with low social anxiety.

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

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

Interconnections between Emotion Recognition, Self-Processes and Psychological Well-Being in Adolescents

Background: Adolescence is a critical developmental period for mentalization and emotion regulation skills. Studies show that during this time, adolescents may experience greater vulnerability to challenges of mental and emotional well-being. Studies also show that self-skills, such as mentalization, self-compassion, and self-control are independently associated with feelings of global self-worth or psychological well-being. To date, no known studies have explored interconnected relations among these self-skills, despite significant overlaps in the social-biological development of these skills. Aims: To investigate interconnected relations among psychological well-being, mentalization, self-compassion and self-control. Gender differences in these relations are explored. Method: As part of a larger, longitudinal study of adolescent well-being, this cross-sectional study drew on a variety of self-report measures, investigating relations among adolescents’ self-reports of psychological well-being, emotion recognition, self-control, and self-compassion. Participants consisted of 88 girls and 57 boys, mean age 13.38. Results: Main results showed associations among emotion recognition, self-control and self-compassion and feelings of global self-worth. Specifically, results showed that understanding negative emotions in others relates to lower levels of self-compassion and feelings of self-worth. Further, adolescents who report low levels of self-control reported uncompassionate self-responding and lower levels of self-worth. Gender differences and implications for further research and adolescent social-emotional interventions are discussed.

A neural signature of exposure to masked faces after 18 months of COVID-19

In the last two years, face-to-face interactions have drastically changed worldwide, because of the COVID-19 pandemic: the persistent use of masks has had the advantage of reducing viral transmission, but it has also had the cost of impacting on the perception and recognition of social information from faces, especially emotions. To assess the cerebral counterpart to this condition, we carried out an EEG experiment, extracting Event-Related Potentials (ERPs) evoked by emotional faces with and without surgical masks. Besides the expected impairment in emotion recognition in both accuracy and response times, also the classical face-related ERPs (N170 and P2) are altered by the presence of surgical masks. Importantly, the effect is stronger in individuals with a lower daily exposure to masks, suggesting that the brain must adapt to an extra constraint in decoding social input, due to masks hiding crucial facial information.

A Systematic Review of the Role of Oxytocin, Cortisol, and Testosterone in Facial Emotional Processing

A topic of interest is the way decoding and interpreting facial emotional expressions can lead to mutual understanding. Facial emotional expression is a basic source of information that guarantees the functioning of other higher cognitive processes (e.g., empathy, cooperativity, prosociality, or decision-making, among others). In this regard, hormones such as oxytocin, cortisol, and/or testosterone have been found to be important in modifying facial emotion processing. In fact, brain structures that participate in facial emotion processing have been shown to be rich in receptors for these hormones. Nonetheless, much of this research has been based on correlational designs. In recent years, a growing number of researchers have tried to carry out controlled laboratory manipulation of these hormones by administering synthetic forms of these hormones. The main objective of this study was to carry out a systematic review of studies that assess whether manipulation of these three hormones effectively promotes significant alterations in facial emotional processing. To carry out this review, PRISMA quality criteria for reviews were followed, using the following digital databases: PsycINFO, PubMed, Dialnet, Psicodoc, Web of Knowledge, and the Cochrane Library, and focusing on manuscripts with a robust research design (e.g., randomized, single- or double-blind, and/or placebo-controlled) to increase the value of this systematic review. An initial identification of 6340 abstracts and retrieval of 910 full texts led to the final inclusion of 101 papers that met all the inclusion criteria. Only about 18% of the manuscripts included reported a direct effect of hormone manipulation. In fact, emotional accuracy seemed to be enhanced after oxytocin increases, but it diminished when cortisol and/or testosterone increased. Nonetheless, when emotional valence and participants' gender were included, hormonal manipulation reached significance (in around 53% of the articles). In fact, these studies offered a heterogeneous pattern in the way these hormones altered speed processing, attention, and memory. This study reinforces the idea that these hormones are important, but not the main modulators of facial emotion processing. As our comprehension of hormonal effects on emotional processing improves, the potential to design good treatments to improve this ability will be greater.

Hydrocortisone as an adjunct to brief cognitive-behavioural therapy for specific fear: Endocrine and cognitive biomarkers as predictors of symptom improvement

BACKGROUND

Glucocorticoid (GC) administration prior to exposure-based cognitive-behavioural therapy (CBT) has emerged as a promising approach to facilitate treatment outcome in anxiety disorders. Further components relevant for improved CBT efficacy include raised endogenous GCs and reductions in information-processing biases to threat.

AIMS

To investigate hydrocortisone as an adjunct to CBT for spider fear and the modulating role of threat bias change and endogenous short-term and long-term GCs for treatment response.

METHODS

Spider-fearful individuals were randomized to receiving either 20 mg of hydrocortisone (n = 17) or placebo (n = 16) one hour prior to single-session predominantly computerised exposure-based CBT. Spider fear was assessed using self-report and behavioural approach measures at baseline, 1-day and 1-month follow-up. Threat processing was assessed at baseline and 1-day follow-up. Cortisol and cortisone were analysed from hair and saliva samples at baseline.

RESULTS/OUTCOMES

Self-report, behavioural and threat processing indices improved following CBT. Hydrocortisone augmentation resulted in greater improvement of self-report spider fear and stronger increase in speed when approaching a spider, but not on threat bias. Neither threat bias nor endogenous GCs predicted symptom change, and no interactive effects with hydrocortisone emerged. Preliminary evidence indicated higher hair cortisone as predictor of a stronger threat bias reduction.

CONCLUSIONS/INTERPRETATION

Our data extend earlier findings by suggesting that GC administration boosts the success of exposure therapy for specific fear even with a low-level therapist involvement. Future studies corroborating our result of a predictive hair GC relationship with threat bias change in larger clinical samples are needed.

Conditioning cortisol in healthy young women - A randomized controlled trial

BACKGROUND

Learned placebo effects induced by pharmacological conditioning affect immune and endocrine outcomes and may offer new possibilities for clinical applications. Whether or not cortisol is subject to this type of associative learning processes, and whether conditioning may affect responses to stress, is currently unclear.

METHOD

A randomized placebo-controlled trial was conducted in 48 healthy young women. During acquisition, participants received a pill containing either 100 mg hydrocortisone (unconditioned stimulus) or placebo, paired with a gustatory conditioned stimulus on three consecutive days. During evocation, all participants received placebo paired with the conditioned stimulus, again on three consecutive days. During the third evocation trial, participants underwent a psychosocial stress task. The main outcome parameter salivary cortisol and secondary outcome parameters salivary alpha-amylase, self-reported positive affect and tension, heart rate, and skin conductance level were measured at several time points.

RESULTS

Significant baseline group differences on cortisol were found at several time points, which complicate the interpretation of group differences. During the first evocation session, the conditioned group showed a moderately smaller cumulative decrease in salivary cortisol from baseline than the placebo control group. No significant differences were found between the groups on cortisol during the second and third evocation or in response to stress, nor on other outcome measures.

CONCLUSION

Although the results provide potential further indications for effects of conditioning on cortisol, baseline differences make it impossible to draw clear conclusions. No indications for possible effects of conditioning on the cortisol stress response or autonomous or affective responses to stress were found.

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

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

The Effect of Lavender (Lavandula stoechas L.) on Reducing Labor Pain: A Systematic Review and Meta-Analysis

BACKGROUND

Labor pain is one of the most severe pains, which most of women experience. By using novel supportive methods, the labor pain can be reduced, which makes this event pleasant and delightful. Several original studies have been conducted in regard to the effect of lavender on reducing labor pain, whose results are controversial. One of the applications of meta-analysis studies is to respond to these hypotheses and remove controversies; therefore, this study aimed to determine the effect of lavender on labor pain in Iran by using meta-analysis.

METHODS

In this study, to find published articles electronically from 2006 to 2019, the published articles in national and international databases of SID, MagIran, IranMedex, IranDoc, Google Scholar, Cochrane Library, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) were used. Heterogenic index between studies was determined by Cochrane test (Q)c and I 2. Due to heterogeneity, the random effects model was used to estimate standardize difference of the mean score of lavender test in order to assess the labor pain between intervention and control group.

RESULTS

In this meta-analysis and systematic review, finally 13 eligible articles met the inclusion criteria of the study. The sample size from original studies enrolled in the meta-analysis entered in the intervention group was 794 individuals and in the control group was 795 individuals. Mean score for pain in the control group was 7.2 ± 0.42 and in the intervention group was 5.4 ± 0.58 and this difference was statistically significant (p ≤ 0.001).

CONCLUSION

The results of this study showed that lavender can reduce labor pain, which can be considered by health policy makers and gynecologists.

Associations between brain activity and endogenous and exogenous cortisol - A systematic review

To arrive at a coherent understanding of the relation between glucocorticoids and the human brain, we systematically reviewed the literature for studies examining the associations between endogenous or exogenous cortisol and human brain function. Higher levels of endogenous cortisol during psychological stress were related to increased activity in the middle temporal gyrus and perigenual anterior cingulate cortex (ACC), decreased activity in the ventromedial prefrontal cortex, and altered function (i.e., mixed findings, increased or decreased) in the amygdala, hippocampus and inferior frontal gyrus. Moreover, endogenous cortisol response to psychological stress was related to increased activity in the inferior temporal gyrus and altered function in the amygdala during emotional tasks that followed psychological stress. Exogenous cortisol administration was related to increased activity in the postcentral gyrus, superior frontal gyrus and ACC, and altered function in the amygdala and hippocampus during conditioning, emotional and reward-processing tasks after cortisol administration. These findings were in line with those from animal studies on amygdala activity during and after stress.

Threat-of-shock decreases emotional interference on affective stroop performance in healthy controls and anxiety patients

Patients with anxiety disorders suffer from impaired concentration, potentially as a result of stronger emotional interference on attention. Studies using behavioural measures provide conflicting support for this hypothesis. Elevated state anxiety may be necessary to reliably document differences in emotional interference in patients versus healthy controls. The present study examines the effect of experimentally induced state anxiety (threat-of-shock) on attention interference by emotional stimuli. Anxiety patients (n = 36) and healthy controls (n = 32) completed a modified affective Stroop task during periods of safety and threat-of-shock. Results indicated that in both patients and controls, threat decreased negative, but not positive or neutral, emotional interference on attention (both p < .001). This finding supports a threat-related narrowing of attention whereby a certain level of anxiety decreases task-irrelevant processing.

Conditioning cortisol in humans: design and pilot study of a randomized controlled trial

Background

Conditioning of physiological responses can be achieved by repeatedly pairing a previously neutral conditioned stimulus with the administration of a pharmacologically salient unconditioned stimulus. This type of conditioning has been effective for specific immune and endocrine responses, but results with regard to conditioning of cortisol, a key stress-regulatory parameter, are currently unclear. This paper describes a pharmacological conditioning design, optimized for the examination of effects of cortisol conditioning under both basal conditions and in response to stress.

Methods

A double-blind randomized controlled conditioning paradigm aimed at conditioning of cortisol is conducted in 48 healthy female volunteers. During the acquisition phase, a gustatory stimulus (conditioned stimulus) is paired with hydrocortisone (100 mg, capsulated, unconditioned stimulus) three times before being administered together with placebo during three evocation sessions. To investigate possible effects of cortisol conditioning in response to stress, participants are exposed to the Trier Social Stress Test during the third evocation session. Primary outcome measure of this study is the mean area under the curve of salivary cortisol during the first two evocation sessions. As secondary outcomes, self-reported affect and stress as well as alpha-amylase are investigated. A pilot study was conducted to ensure that this design is feasible to be used in a larger study.

Discussion

This study design provides an innovative opportunity to examine the conditioning of cortisol under basal conditions and in response to stress. Also, the possible effect of cortisol conditioning on secondary outcomes of self-reported affect and alpha-amylase can be investigated. If cortisol could successfully be conditioned, this would be of conceptual relevance, showing that hypothalamic pituitary adrenal (HPA) axis regulation can be influenced by associative learning processes. Eventually, this could also have important clinical implications for understanding and treating stress-related disorders in which HPA axis dysregulation might play a role.

Trial registration

Nederlands Trial Register, NTR4651. Registered on 29 July 2014

Electronic supplementary material

The online version of this article (10.1186/s40814-018-0382-5) contains supplementary material, which is available to authorized users.

ERP Evidence for Inhibitory Control Deficits in Test-Anxious Individuals

Introduction: Individuals with test anxiety [i.e., high test anxiety (HTA)] always treat tests/examinations as a potential threat. This cognitive mode impairs these individuals' ability of inhibitory control and leads to a high level of anxiety. However, characterizing aspects of HTA's impaired inhibitory control ability are unclear and need to be studied. Methods: Forty-six participants were recruited and divided into a HTA (N = 26) and low test anxiety (LTA; i.e., healthy control; N = 20) group. Self-reports (Test Anxiety Scale, State-Trait Anxiety Inventory for negative emotions) were obtained. An emotional Stroop (ES) task and a numerical Stroop (NS) task, causing different types of interferences, were used for assessing the emotional and cognitive aspects of attentional control ability (behavioral data). Event-related brain potentials (ERPs) were registered to further assess processing stages related to different aspects of attentional control ability. Results: Compared with the LTA group, the HTA group has inhibitory control deficits of both emotional (see ERP components P1-P2-N2 and P3) and cognitive (see ERP component P3) interference. Compared with the LTA group, the HTA doesn't have lower accuracy in neither ES nor NS but displays longer reaction times only in ES. Additionally, the HTA group's ES results also show that (1) the degree of emotional interference indicates the level of an individual's anxiety, and (2) the ERP component P2 may serve as an index of the level of test anxiety. Conclusion: HTA individuals have extensive inhibitory deficits for both emotional and cognitive aspects; however, impairment impacts more on emotional aspects than on cognitive aspects. Additionally, as compared to NS, the negative impact of more impaired processing stages on task performance is more substantial in ES.

From words to action: Implicit attention to antisocial semantic cues predicts aggression and amygdala reactivity to angry faces in healthy young women

Implicit measures of aggressiveness are able to circumvent response biases that plague self-reports, but it is unclear how they link to neural activation during aggressive interactions and to aggression-related endocrine function. Here, we tested whether an implicit attentional bias toward antisocial semantic information was associated with endogenous testosterone (T) and cortisol (C) levels, as well as with aggressive behavior and amygdala reactivity to angry faces in a separate competitive paradigm. On Day one, participants (39 healthy young women) completed an emotional word Stroop task in which they had to indicate the font color of antisocial, prosocial, or neutral words. On Day two, we measured subjects' brain activity during a competitive reaction time task in which the female opponent displayed angry or neutral facial expressions at the start of each trial and provoked participants with increasingly strong sound blasts. T and C were measured in saliva during a regular weekday as well as before and after scanning. We previously showed that aggression was associated with enhanced amygdala reactivity to angry faces in this sample. The present analyses revealed that subjects were slower to identify the font color of antisocial relative to neutral words, and that this attentional bias predicted higher aggression. T and C were uncorrelated with Stroop scores. Crucially, the relationship between implicit attention to antisocial words and aggression was mediated by amygdala reactivity to angry faces. Our data indicate that a tendency to dwell on implicit hostile cues reflects enhanced responsivity to overt anger displays.

The Impact of Top-Down Prediction on Emotional Face Processing in Social Anxiety

There is evidence that people with social anxiety show abnormal processing of emotional faces. To investigate the impact of top-down prediction on emotional face processing in social anxiety, brain responses of participants with high and low social anxiety (LSA) were recorded, while they performed a variation of the emotional task, using high temporal resolution event-related potential techniques. Behaviorally, we reported an effect of prediction with higher accuracy for predictable than unpredictable faces. Furthermore, we found that participants with high social anxiety (HSA), but not with LSA, recognized angry faces more accurately than happy faces. For the P100 and P200 components, HSA participants showed enhanced brain activity for angry faces compared to happy faces, suggesting a hypervigilance to angry faces. Importantly, HSA participants exhibited larger N170 amplitudes in the right hemisphere electrodes than LSA participants when they observed unpredictable angry faces, but not when the angry faces were predictable. This probably reflects the top-down prediction improving the deficiency at building a holistic face representation in HSA participants.

How does gaze direction affect facial processing in social anxiety? -An ERP study

Previous behavioral studies have demonstrated an effect of eye gaze direction on the processing of emotional expressions in adults with social anxiety. However, specific brain responses to the interaction between gaze direction and facial expressions in social anxiety remain unclear. The present study aimed to explore the time course of such interaction using event-related potentials (ERPs) in participants with social anxiety. High socially anxious individuals and low socially anxious individuals were asked to identify the gender of angry or neutral faces with direct or averted gaze while their behavioral performance and electrophysiological data were monitored. We found that identification of angry faces with direct but not averted gaze elicited larger N2 amplitude in high socially anxious individuals compared to low socially anxious individuals, while identification of neutral faces did not produce any gaze modulation effect. Moreover, the N2 was correlated with increased anxiety severity upon exposure to angry faces with direct gaze. Therefore, our results suggest that gaze direction modulates the processing of threatening faces in social anxiety. The N2 component elicited by angry faces with direct gaze could be a state-dependent biomarker of social anxiety and may be an important reference biomarker for social anxiety diagnosis and intervention.

Biological markers for anxiety disorders, OCD and PTSD: A consensus statement. Part II: Neurochemistry, neurophysiology and neurocognition

OBJECTIVE

Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD).

METHODS

Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network.

RESULTS

The present article (Part II) summarises findings on potential biomarkers in neurochemistry (neurotransmitters such as serotonin, norepinephrine, dopamine or GABA, neuropeptides such as cholecystokinin, neurokinins, atrial natriuretic peptide, or oxytocin, the HPA axis, neurotrophic factors such as NGF and BDNF, immunology and CO2 hypersensitivity), neurophysiology (EEG, heart rate variability) and neurocognition. The accompanying paper (Part I) focuses on neuroimaging and genetics.

CONCLUSIONS

Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high quality research has accumulated that should improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.

Glucocorticoid Administration Improves Aberrant Fear-Processing Networks in Spider Phobia

Glucocorticoids reduce phobic fear in patients with anxiety disorders. Previous studies have shown that fear-related activation of the amygdala can be mediated through the visual cortical pathway, which includes the fusiform gyrus, or through other pathways. However, it is not clear which of the pathways that activate the amygdala is responsible for the pathophysiology of a specific phobia and how glucocorticoid treatment alleviates fear processing in these neural networks. We recorded the brain activity with functional magnetic resonance imaging in patients with spider phobia, who received either 20 mg of cortisol or a placebo while viewing pictures of spiders. We also tested healthy participants who did not receive any medication during the same task. We performed dynamic causal modelling (DCM), a connectivity analysis, to examine the effects of cortisol on the networks involved in processing fear and to examine if there was an association between these networks and the symptoms of the phobia. Cortisol administration suppressed the phobic stimuli-related amygdala activity to levels comparable to the healthy participants and reduced subjective phobic fear. The DCM analysis revealed that cortisol administration suppressed the aberrant inputs into the amygdala that did not originate from the visual cortical pathway, but rather from a fast subcortical pathway mediated by the pulvinar nucleus, and suppressed the interactions between the amygdala and fusiform gyrus. This network changes were distinguishable from healthy participants and considered the residual changes under cortisol administration. We also found that the strengths of the aberrant inputs into the amygdala were positively correlated with the severity of spider phobia. This study demonstrates that patients with spider phobia show an aberrant functional connectivity of the amygdala when they are exposed to phobia-related stimuli and that cortisol administration can alleviate this fear-specific neural connectivity.

No effects of psychosocial stress on memory retrieval in non-treated young students with Generalized Social Phobia

Generalized Social Phobia (GSP) is a common anxiety disorder that produces clear social life disruptions. There is no consensus on the specific processes involved in its development, but the role of the hypothalamic-pituitary-adrenal (HPA) axis has been suggested. This study analyzed the effects of the cortisol response to the Trier Social Stress Test (TSST) on the memory retrieval of pictures with different emotional valences in 45 non-treated young students with GSP and 50 non-anxious (NA) subjects (mean=19.35years, SD=0.18). No differences were found in the cortisol response of GSP and NA subjects to the TSST and control sessions. In addition, psychosocial stress impaired memory retrieval in both the GSP and NA groups, with no differences between them. Regarding the sex factor, no effects were found in the cortisol response to the TSST. However, during the encoding session, GSP men had higher cortisol levels than GSP women and NA subjects. There was also a significant interaction between sex and stress exposure on memory retrieval. Women recognized more unpleasant and neutral pictures than men; however, under stress, the women's advantage disappeared, and the men's performance improved. Sex also interacted with social phobia on positive mood, with GSP women exposed to the TSST showing the lowest positive mood. These results suggest that GSP subjects do not present an HPA axis sensitization to psychosocial stress, and they emphasize the importance of Sex in understanding stress effects on memory.

Long-term academic stress enhances early processing of facial expressions

Exposure to long-term stress can lead to a variety of emotional and behavioral problems. Although widely investigated, the neural basis of how long-term stress impacts emotional processing in humans remains largely elusive. Using event-related brain potentials (ERPs), we investigated the effects of long-term stress on the neural dynamics of emotionally facial expression processing. Thirty-nine male college students undergoing preparation for a major examination and twenty-one matched controls performed a gender discrimination task for faces displaying angry, happy, and neutral expressions. The results of the Perceived Stress Scale showed that participants in the stress group perceived higher levels of long-term stress relative to the control group. ERP analyses revealed differential effects of long-term stress on two early stages of facial expression processing: 1) long-term stress generally augmented posterior P1 amplitudes to facial stimuli irrespective of expression valence, suggesting that stress can increase sensitization to visual inputs in general, and 2) long-term stress selectively augmented fronto-central P2 amplitudes for angry but not for neutral or positive facial expressions, suggesting that stress may lead to increased attentional prioritization to processing negative emotional stimuli. Together, our findings suggest that long-term stress has profound impacts on the early stages of facial expression processing, with an increase at the very early stage of general information inputs and a subsequent attentional bias toward processing emotionally negative stimuli.

The effects of long-term stress on neural dynamics of working memory processing: An investigation using ERP

This study examined the neural dynamics of working memory (WM) processing under long-term stress. Forty participants who had been exposed to a long period of major exam preparation (six months) and twenty-one control participants performed a numerical n-back task (n = 1, 2) while electroencephalograms were recorded. Psychological and endocrinal measurements confirmed significantly higher levels of long-term stress for participants in the exam group. The exam group showed significantly increased P2 amplitude in the frontal-central sites in the 1-back and 2-back conditions, whereas other ERP components, including the P1, N1 and P3 and behavioral performance, were unchanged. Notably, the P2 effect was most pronounced in participants in the exam group who reported perceiving high levels of stress. The perceived stress scores positively correlated with the P2 amplitude in the 1-back and 2-back conditions. These results suggest that long-term stress has an impact on attention and the initiation of the updating process in WM.

The Effect of Affective Context on Visuocortical Processing of Neutral Faces in Social Anxiety

It has been demonstrated that verbal context information alters the neural processing of ambiguous faces such as faces with no apparent facial expression. In social anxiety, neutral faces may be implicitly threatening for socially anxious individuals due to their ambiguous nature, but even more so if these neutral faces are put in self-referential negative contexts. Therefore, we measured event-related brain potentials (ERPs) in response to neutral faces which were preceded by affective verbal information (negative, neutral, positive). Participants with low social anxiety (LSA; n = 23) and high social anxiety (HSA; n = 21) were asked to watch and rate valence and arousal of the respective faces while continuous EEG was recorded. ERP analysis revealed that HSA showed elevated P100 amplitudes in response to faces, but reduced structural encoding of faces as indexed by reduced N170 amplitudes. In general, affective context led to an enhanced early posterior negativity (EPN) for negative compared to neutral facial expressions. Moreover, HSA compared to LSA showed enhanced late positive potentials (LPP) to negatively contextualized faces, whereas in LSA this effect was found for faces in positive contexts. Also, HSA rated faces in negative contexts as more negative compared to LSA. These results point at enhanced vigilance for neutral faces regardless of context in HSA, while structural encoding seems to be diminished (avoidance). Interestingly, later components of sustained processing (LPP) indicate that LSA show enhanced visuocortical processing for faces in positive contexts (happy bias), whereas this seems to be the case for negatively contextualized faces in HSA (threat bias). Finally, our results add further new evidence that top-down information in interaction with individual anxiety levels can influence early-stage aspects of visual perception.

The temporal primacy of self-related stimuli and negative stimuli: an ERP-based comparative study

Numerous studies have shown there exist attention biases for self-related and negative stimuli. Few studies, however, have been carried out to compare the effects of such stimuli on the neural mechanisms of early attentional alertness and subsequent cognitive processing. The purpose of the present study was to examine the temporal primacy of both self-related stimuli and negative stimuli in the neurophysiologic level. In a modified oddball task, event-related potentials of the deviant stimuli (i.e., self-face, negative face and neutral face) were recorded. Results revealed that larger P2 amplitudes were elicited by self-related and negative stimuli than by neutral stimuli. Negative stimuli, however, elicited shorter P2 latencies than self-related and neutral stimuli. As for the N2 component, self-related and negative stimuli elicited smaller amplitudes and shorter latencies than neutral stimuli, but otherwise did not differ. Self-related stimuli also elicited larger P3 and late positive component (LPC) amplitudes than negative and neutral stimuli. The pattern of results suggests that the primacy of negative stimuli occurred at an early attention stage of processing, while the primacy of self-related stimuli occurred at the subsequent cognitive evaluation and memory stage.

Top-Down Control of Serotonin Systems by the Prefrontal Cortex: A Path toward Restored Socioemotional Function in Depression

Social withdrawal, increased threat perception, and exaggerated reassurance seeking behaviors are prominent interpersonal symptoms in major depressive disorder (MDD). Altered serotonin (5-HT) systems and corticolimbic dysconnectivity have long been suspected to contribute to these symptomatic facets; however, the underlying circuits and intrinsic cellular mechanisms that control 5-HT output during socioemotional interactions remain poorly understood. We review literature that implicates a direct pathway between the ventromedial prefrontal cortex (vmPFC) and dorsal raphe nucleus (DRN) in the adaptive and pathological control of social approach-avoidance behaviors. Imaging and neuromodulation during approach-avoidance tasks in humans point to the cortical control of brainstem circuits as an essential regulator of socioemotional decisions and actions. Parallel rodent studies using viral-based connectomics and optogenetics are beginning to provide a cellular blueprint of the underlying circuitry. In these studies, manipulations of vmPFC synaptic inputs to the DRN have revealed bidirectional influences on socioaffective behaviors via direct monosynaptic excitation and indirect disynaptic inhibition of 5-HT neurons. Additionally, adverse social experiences that result in permanent avoidance biases, such as social defeat, drive long-lasting plasticity in this microcircuit, potentiating the indirect inhibition of 5-HT output. Conversely, neuromodulation of the vmPFC via deep brain stimulation (DBS) attenuates avoidance biases by restoring the direct excitatory drive of 5-HT neurons and strengthening a key subset of forebrain 5-HT projections. Better understanding the cellular organization of the vmPFC-DRN pathway and identifying molecular determinants of its neuroplasticity can open fundamentally novel avenues for the treatment of affective disorders.

The effect of relaxation interventions on cortisol levels in HIV-seropositive women

PURPOSE

Activation of the hypothalamic-pituitary-adrenal axis, assessed in terms of cortisol levels, may enhance the ability of HIV to infect lymphocytes and downregulate the immune system, accelerating disease progression. This study sought to determine the effects of relaxation techniques on cortisol levels in HIV-seropositive women.

METHODS

Women (n = 150) were randomized to a group cognitive-behavioral stress management (CBSM) condition or an individual information condition and underwent 3 types of relaxation training (progressive muscle relaxation, imagery, and autogenic training). Cortisol levels were obtained pre- and postrelaxation.

RESULTS

Guided imagery was effective in reducing cortisol in the group condition (t = 3.90, P < .001), and muscle relaxation reduced cortisol in the individual condition (t = 3.1 I, P = .012). Among participants in the group condition attending all sessions, the magnitude of pre- to postsession reduction became greater over time.

CONCLUSIONS

Results suggest that specific relaxation techniques may be partially responsible for cortisol decreases associated with relaxation and CBSM.

Investigation of cortisol levels in patients with anxiety disorders: a structured review

Anxiety disorders are common and distressing medical conditions, which typically arise in adolescence or early adult life. They can persist for many years, reducing quality of life, limiting academic and occupational achievement, and being responsible for considerable economic pressures. Although a range of psychological and pharmacological treatments are available, their success is often limited, and many patients remain troubled by significant symptom-related disability for long periods. The detailed pathophysiology of each anxiety disorder is not established, and novel treatments that are based solely on current understanding of conventional neurotransmitter function are unlikely to be substantially more effective or better tolerated than current treatments. Investigations of hypothalamo-pituitary axis function across panic disorder, generalized anxiety disorder, specific phobias and social anxiety disorder have produced intriguing findings but not revealed a consistent pattern of endocrine disturbance, perhaps reflecting differences in methodology and the nature and size of the clinical samples. There is a persistent need for large, prospective studies using standardized methods for investigation and data analysis (164 words).

Reduced processing of facial and postural cues in social anxiety: insights from electrophysiology

Social anxiety is characterized by fear of evaluative interpersonal situations. Many studies have investigated the perception of emotional faces in socially anxious individuals and have reported biases in the processing of threatening faces. However, faces are not the only stimuli carrying an interpersonal evaluative load. The present study investigated the processing of emotional body postures in social anxiety. Participants with high and low social anxiety completed an attention-shifting paradigm using neutral, angry and happy faces and postures as cues. We investigated early visual processes through the P100 component, attentional fixation on the P2, structural encoding mirrored by the N170, and attentional orientation towards stimuli to detect with the P100 locked on target occurrence. Results showed a global reduction of P100 and P200 responses to faces and postures in socially anxious participants as compared to non-anxious participants, with a direct correlation between self-reported social anxiety levels and P100 and P200 amplitudes. Structural encoding of cues and target processing were not modulated by social anxiety, but socially anxious participants were slower to detect the targets. These results suggest a reduced processing of social postural and facial cues in social anxiety.

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.

Altered processing of emotional stimuli in migraine: an event-related potential study

BACKGROUND

Migraine patients report psychosocial stress to be among the major triggers for their migraine attacks. The mechanisms underlying the onset of migraine attacks are not yet fully understood. Neuroimaging studies have shown changes in the cortical excitability of migraine patients. Here, we investigated cortical activation related to processing of emotional stimuli in individuals with migraine.

METHOD

Twenty-four participants suffering from migraine attacks and 25 healthy volunteers had to passively observe pictures of emotional facial expressions (angry, happy and neutral). Electro-cortical activity was continuously recorded by means of an electroencephalogram (EEG), and ratings of valence (unpleasant vs. pleasant) and arousal (calm vs. exciting) were collected.

RESULTS

The migraine and control group did not differ in their ratings of valence and arousal of the visual stimuli. However, participants with migraine, in contrast to healthy controls, showed larger N170 amplitudes toward angry facial expressions compared to neutral ones.

DISCUSSION

Individuals with migraine may have an altered cortical activity linked to the processing of emotional information. Thus, these individuals may process high arousing and threatening events preferentially, and this facilitated processing may be related to their already high cortical excitability.

Automaticity in anxiety disorders and major depressive disorder

In this paper we examine the nature of automatic cognitive processing in anxiety disorders and Major Depressive Disorder (MDD). Rather than viewing automaticity as a unitary construct, we follow a social cognition perspective (Bargh, 1994) that argues for four theoretically independent features of automaticity: unconscious (processing of emotional stimuli occurs outside awareness), efficient (processing emotional meaning uses minimal attentional resources), unintentional (no goal is needed to engage in processing emotional meaning), and uncontrollable (limited ability to avoid, alter or terminate processing emotional stimuli). Our review of the literature suggests that most anxiety disorders are characterized by uncontrollable, and likely also unconscious and unintentional, biased processing of threat-relevant information. In contrast, MDD is most clearly typified by uncontrollable, but not unconscious or unintentional, processing of negative information. For the anxiety disorders and for MDD, there is no sufficient evidence to draw firm conclusions about efficiency of processing, though early indications are that neither anxiety disorders nor MDD are characterized by this feature. Clinical and theoretical implications of these findings are discussed and directions for future research are offered. In particular, it is clear that paradigms that more directly delineate the different features of automaticity are required to gain a more comprehensive and systematic understanding of the importance of automatic processing in emotion dysregulation.

Testosterone, cortisol, and serotonin as key regulators of social aggression: A review and theoretical perspective

In human and non-human animals the steroid hormones cortisol and testosterone are involved in social aggression and recent studies suggest that these steroids might jointly regulate this behavior. It has been hypothesized that the imbalance between cortisol and testosterone levels is predictive for aggressive psychopathology, with high testosterone to cortisol ratio predisposing to a socially aggressive behavioral style. In this review, we focus on the effects of cortisol and testosterone on human social aggression, as well as on how they might modulate the aggression circuitry of the human brain. Recently, serotonin is hypothesized to differentiate between impulsive and instrumental aggression, and we will briefly review evidence on this hypothesis. The aim of this article is to provide a theoretical framework for the role of steroids and serotonin in impulsive social aggression in humans.

Cortisol acutely reduces selective attention for erotic words in healthy young men

Psychological stress prompts activity of the hypothalamic-pituitary-adrenal (HPA) axis resulting in increased release of cortisol. Long-term HPA aberrations have been observed for stress-related affective disorders but research into acute effects of cortisol on affect-regulation has only recently begun. Previous studies reported that exogenous cortisol acutely attenuated automatic attentional processing of task-irrelevant threatening information. This has been taken to suggest that cortisol may have acute anxiolytic properties, possibly through facilitating inhibition of threatening information. However, the role of cortisol in attentional inhibition of non-threatening arousing stimuli remained unclear. Therefore acute effects of 40 mg cortisol on performance of a masked and unmasked emotional Stroop task (EST) were assessed. Results for only the unmasked task demonstrated EST interference (interpreted as increased automatic attention) for erotic stimuli which was abolished by cortisol administration. This implies that effects of cortisol may not be restricted to attenuation of specifically anxiogenic information processing, as previously suggested.

Effects of single cortisol administrations on human affect reviewed: Coping with stress through adaptive regulation of automatic cognitive processing

The human stress hormone cortisol may facilitate effective coping after psychological stress. In apparent agreement, administration of cortisol has been demonstrated to reduce fear in response to stressors. For anxious patients with phobias or posttraumatic stress disorder this has been ascribed to hypothetical inhibition of retrieval of traumatic memories. However, such stress-protective effects may also work via adaptive regulation of early cognitive processing of threatening information from the environment. This paper selectively reviews the available literature on effects of single cortisol administrations on affect and early cognitive processing of affectively significant information. The concluded working hypothesis is that immediate effects of high concentration of cortisol may facilitate stress-coping via inhibition of automatic processing of goal-irrelevant threatening information and through increased automatic approach-avoidance responses in early emotional processing. Limitations in the existing literature and suggestions for future directions are briefly discussed.

Exogenous cortisol facilitates responses to social threat under high provocation

Stress is one of the most important promoters of aggression. Human and animal studies have found associations between basal and acute levels of the stress hormone cortisol and (abnormal) aggression. Irrespective of the direction of these changes--i.e., increased or decreased aggressive behavior--the results of these studies suggest dramatic alterations in the processing of threat-related social information. Therefore, the effects of cortisol and provocation on social information processing were addressed by the present study. After a placebo-controlled pharmacological manipulation of acute cortisol levels, we exposed healthy individuals to high or low levels of provocation in a competitive aggression paradigm. Influences of cortisol and provocation on emotional face processing were then investigated with reaction times and event-related potentials (ERPs) in an emotional Stroop task. In line with previous results, enhanced early and later positive, posterior ERP components indicated a provocation-induced enhanced relevance for all kinds of social information. Cortisol, however, reduced an early frontocentral bias for angry faces and--despite the provocation-enhancing relevance--led to faster reactions for all facial expressions in highly provoked participants. The results thus support the moderating role of social information processing in the 'vicious circle of stress and aggression'.