Single dose testosterone administration alleviates gaze avoidance in women with Social Anxiety Disorder

Threat sensitivity in emotion dynamics: Negativity effects and sex differences

Evolutionary theorizing has given rise to the idea that responding to any particular threat may be more mandatory than responding to any particular reward. The present three experiments (total N = 375) sought to provide support for this perspective in an emotion dynamics task in which participants continuously rated their affective state in response to appetitive (reward-related) versus aversive (threat-related) images. Even when equating images for arousal and extremity, several negativity effects (e.g., steeper reactivity slopes in response to aversive images) were found. These negativity effects can serve as an experimental model of threat sensitivity, which should predispose some individuals, more than others, to symptoms related to fear and anxiety. This point was made with respect to sex differences, given that women (relative to men) are diagnosed with anxiety disorders at higher rates. Sex differences were pronounced and extensions of this work, both basic and applied, are proposed.

Testosterone administration decreases sensitivity to angry facial expressions in healthy males: A computational modeling approach

Previous research indicates that higher testosterone levels are related to increased aggressive and dominant behaviors, particularly in males. One possible mechanism for these hormone-behavior associations could involve threat perception. However, the causal influence of testosterone on men's recognition of threatening facial expressions remains unknown. Here, we tested the causal effect of exogenous testosterone on men's sensitivity to facial threat by combining a psychophysical task with computational modeling. We administered a single dose (150 mg) of testosterone or placebo gel to healthy young men (n = 120) in a double-blind, placebo-controlled, between-participant design. Participants were presented with morphed emotional faces mixing anger/fear and neutral expressions and made judgments about the emotional expression. Across typical regression analysis, signal detection analysis, and drift diffusion modeling, our results consistently showed that individuals who received testosterone (versus placebo) exhibited a lower perceived sensitivity to angry facial expressions. But we observed no significant effects of testosterone administration on fearful facial expressions. The findings indicate that testosterone attenuates sensitivity to facial threat, especially angry facial expressions, which could lead to a misestimation of others' dominance and an increase in one's own aggressive and dominant behaviors.

Social avoidance and testosterone enhanced exposure efficacy in women with social anxiety disorder: A pilot investigation

Social avoidance has been associated with more persistent social anxiety disorder (SAD) symptoms and low testosterone levels in individuals with SAD. We tested whether pre-treatment avoidance tendencies moderate the efficacy of testosterone-augmented exposure therapy. Fifty-five females with SAD received two exposure sessions during which fear levels were assessed. Session 1 was augmented with testosterone (0.50 mg) or placebo. Avoidance tendencies and symptom severity were assessed pre- and post-exposure. Participants showed stronger avoidance for social versus non-social stimuli and this tendency remained stable over time. Stronger pretreatment avoidance tendencies were associated with larger fear reduction in the testosterone but not the placebo condition. This effect did not transfer to the second non-enhanced session or symptom severity. The findings support the hypothesis that individuals suffering from SAD with relatively stronger pretreatment avoidance tendencies benefit more from testosterone-augmentation, pointing to a potential behavioral marker for testosterone enhancement of exposure therapy.

A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people

This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.

Attentional processes during emotional face perception in social anxiety disorder: A systematic review and meta-analysis of eye-tracking findings

Background In recent years, a growing body of eye-tracking research has investigated gaze behavior in individuals with social anxiety during the visual perception of emotional stimuli. The aim of this article was to review and synthesize studies examining attention orientation in patients with clinical social anxiety by means of eye-tracking methodology. Methods Through a systematic search, 30 articles were identified, including 11 studies in which single emotional faces were used as stimuli and seven eligible studies in which threatening faces were paired with neutral stimuli. Meta-analyses were conducted to compare prolonged eye-contact behavior and early attentional biases to threats in individuals with social anxiety disorder (SAD) and healthy controls. Results Moderate group differences were revealed for single face viewing studies, with SAD patients showing significantly reduced eye contact with negative (Hedges' g = -0.67) and positive emotional faces (g = -0.49) compared to that of healthy participants. Type of task and duration of stimulus presentation were (marginally) significant moderators of between-study variance in effect size. Small but significant group differences were found for early attentional biases toward angry faces versus neutral stimuli (g = 0.21) but not toward happy faces versus neutral stimuli (g = 0.05). Preliminary evidence for a hyperscanning strategy in SAD patients relative to healthy controls emerged (g = 0.42). Limitations The number of included studies with face pairings was low, and two studies were excluded due to unavailable data. Conclusions Our results suggest that eye contact avoidance with emotional faces is a prominent feature in SAD patients. Patients might benefit from guidance to learn to make adequate eye contact during therapeutic interventions, such as exposure therapy. SAD patients demonstrated slightly heightened attention allocation toward angry faces relative to that of healthy participants during early processing stages. Threat biases can be potential targets for attention modification training as an adjuvant to other treatments. Future research on early attentional processes may benefit from improved arrangements of paired stimuli to increase the psychometric properties of initial attention indices.

The enhancing effects of testosterone in exposure treatment for social anxiety disorder: a randomized proof-of-concept trial

Individuals with a social anxiety disorder (SAD) show hypofunctioning of the hypothalamus-pituitary-gonadal (HPG) axis, which is linked to social fear and avoidance behavior. As testosterone administration has been shown to facilitate social-approach behavior in this population, it may enhance the effectiveness of exposure treatment. In this proof-of-concept study, we performed a randomized clinical assay in which 55 women diagnosed with SAD received two exposure therapy sessions. Session 1 was supplemented with either testosterone (0.50 mg) or placebo. Next, transfer effects of testosterone augmentation on within-session subjective fear responses and SAD symptom severity were assessed during a second, unenhanced exposure session (session 2) and at a 1-month follow-up, respectively. The participants having received testosterone showed a more reactive fear pattern, with higher peaks and steeper reductions in fear levels in session 2. Post-hoc exploration of moderating effects of endogenous testosterone levels, revealed that this pattern was specific for women with high basal testosterone, both in the augmented and in the transfer session. In contrast, the participants with low endogenous testosterone showed reduced peak fear levels throughout session 1, again with transfer to the unenhanced session. Testosterone did not significantly affect self-reported anxiety. The effects of testosterone supplementation on fear levels show transfer to non-enhanced exposure, with effects being modulated by endogenous testosterone. These first preliminary results indicate that testosterone may act on important fear mechanisms during exposure, providing the empirical groundwork for further exploration of multi-session testosterone-enhanced exposure treatment for SAD.

Pubertal Testosterone and Brain Response to Faces in Young Adulthood: An Interplay between Organizational and Activational Effects in Young Men

According to the organizational-activational hypothesis, the organizational effects of testosterone during (prenatal) brain development moderate the activational effects of adult testosterone on behavior. Accumulating evidence supports the notion that adolescence is another period during which sex hormones organize the nervous system. Here we investigate how pubertal sex hormones moderate the activational effects of adult sex hormones on social cognition in humans. To do so, we recruited a sample of young men (n = 507; age, ∼19 years) from a longitudinal birth cohort and investigated whether testosterone exposure during adolescence (from 9 to 17 years of age) moderates the relation between current testosterone and brain response to faces in young adulthood, as assessed with functional magnetic resonance imaging (fMRI). Our results showed that the cumulative exposure to testosterone during adolescence moderated the relation between adult testosterone and both the mean fMRI response and functional connectivity (i.e., node strength). Specifically, in participants with low exposure to testosterone during puberty, we observed a positive relationship between current testosterone and the brain response to faces; this was not the case for participants with medium and high pubertal testosterone. Furthermore, we observed a stronger relationship between the brain response and current testosterone in parts of the angry-face network associated with (vs without) motion in the eye region of an observed (angry) face. We speculate that pubertal testosterone modulates the relationship between current testosterone and brain response to social cues carried by the eyes and signaling a potential threat.SIGNIFICANCE STATEMENT Accumulating evidence supports the organizational effects of pubertal testosterone, but the body of literature examining these effects on social cognition in humans is in its infancy. With a sample of young men from a longitudinal birth cohort, we showed that the cumulative exposure to testosterone during adolescence moderated the relation between adult testosterone and both the mean BOLD signal change and functional connectivity. Specifically, we observed a positive relationship between adult testosterone and the brain response to faces in participants with low exposure to testosterone during puberty, but not in participants with medium and high pubertal testosterone. Results of further analysis suggest that sensitivity to cues carried by the eyes might underlie the relationship between testosterone and brain response to faces, especially in the context of a potential threat.

Testosterone administration in women increases the size of their peripersonal space

Peripersonal space (PPS) is the space immediately surrounding the body, conceptualised as a sensory-motor interface between body and environment. PPS size differs between individuals and contexts, with intrapersonal traits and states, as well as social factors having a determining role on the size of PPS. Testosterone plays an important role in regulating social-motivational behaviour and is known to enhance dominance motivation in an implicit and unconscious manner. We investigated whether the dominance-enhancing effects of testosterone reflect as changes in the representation of PPS in a within-subjects testosterone administration study in women (N = 19). Participants performed a visuo-tactile integration task in a mixed-reality setup. Results indicated that the administration of testosterone caused a significant enlargement of participants' PPS, suggesting that testosterone caused participants to implicitly appropriate a larger space as their own. These findings suggest that the dominance-enhancing effects of testosterone reflect at the level of sensory-motor processing in PPS.

Sex differences in progestogen- and androgen-derived neurosteroids in vulnerability to alcohol and stress-related disorders

Stress and trauma exposure disturbs stress regulation systems and thus increases the vulnerability for stress-related disorders which are characterized by negative affect, including major depressive disorder, anxiety disorders and posttraumatic stress disorder. Similarly, stress and trauma exposure results in increased vulnerability to problematic alcohol use and alcohol use disorder, especially among women, who are more likely to drink to cope with negative affect than their male counterparts. Given these associations, the relationship between stress-related disorders and alcohol use is generally stronger among women leading to complex comorbidities across these disorders and alcohol misuse. This review highlights the therapeutic potential for progestogen- and androgen-derived neurosteroids, which affect both stress- and alcohol-related disorders, to target the overlapping symptoms related to negative affect. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'

A longitudinal investigation of bidirectional and time-dependent interrelationships between testosterone and training motivation in an elite rugby environment

In sport, testosterone has been positioned as a substrate for motivation with both directional and time dependencies. However, evidence is scarce when considering the complexities of competitive sport and no work has explicitly modeled these dependencies. To address these gaps, we investigated the bidirectional and time-dependent interrelationships between testosterone and training motivation in an elite rugby environment. Thirty-six male athletes were monitored across training weeks before and after eight international rugby matches. Pre-breakfast measures of salivary testosterone and training motivation (1-10 rating) were taken on training, competition, and recovery days (up to 40 tests). Using a continuous-time (CT) model, within-person estimates of autoregressive effects (persistence) and cross-lagged effects (relationships) were derived. A stronger, more persistent temporal association was identified for testosterone than for motivation. Cross-lagged effects verified that training motivation was positively related to testosterone at latter time points (p < 0.001). Discrete-time analyses revealed a non-linear association; increasing in strength from a zero-time lag to peak after 2.83 days (standardized effect = 0.25), before dissipation over longer lagged intervals. The testosterone relationship with ensuing training motivation was also positive, but non-significant. Match effects also appeared (p < 0.001) with a predicted decline in training motivation, but a rise in testosterone, at match onset. In summary, a positive association emerged between within-person fluctuations in self-appraised motivation to train and testosterone concentration in an elite rugby environment. The lagged, non-linear nature of this relationship and match predictions on both outcomes support, and extend, theoretical models linking testosterone and competitive behaviors.

Molecular and neurocircuitry mechanisms of social avoidance

Humans and animals live in social relationships shaped by actions of approach and avoidance. Both are crucial for normal physical and mental development, survival, and well-being. Active withdrawal from social interaction is often induced by the perception of threat or unpleasant social experience and relies on adaptive mechanisms within neuronal networks associated with social behavior. In case of confrontation with overly strong or persistent stressors and/or dispositions of the affected individual, maladaptive processes in the neuronal circuitries and its associated transmitters and modulators lead to pathological social avoidance. This review focuses on active, fear-driven social avoidance, affected circuits within the mesocorticolimbic system and associated regions and a selection of molecular modulators that promise translational potential. A comprehensive review of human research in this field is followed by a reflection on animal studies that offer a broader and often more detailed range of analytical methodologies. Finally, we take a critical look at challenges that could be addressed in future translational research on fear-driven social avoidance.

Single-Dose of Testosterone and the MAOA VNTR Polymorphism Influence Emotional and Behavioral Responses in Men During a Non-social Frustration Task

Previous studies suggest that testosterone and several neurotransmitters might interactively influence human aggression. The current study aimed to test potential interactions of a genetic variation linked to the catabolism of serotonin, dopamine, and norepinephrine and exogenous testosterone on the reaction towards non-social provocation. In total, 146 male participants were genotyped for a prominent polymorphism of the monoamine oxidase A (MAOA) gene resulting in a short and long variant. Participants completed a non-social frustration task after receiving either testosterone or a placebo gel in a double-blind set-up. Participants performed a non-social frustration task, where they had to direct a virtually moving ball into a barrel by pulling a joystick (neutral block). During a frustration block, the joystick repeatedly did not respond to participants' reactions thereby causing failed trials to which participants reacted with increased anger and stronger pulling of the joystick. We analyzed the effect of testosterone administration on emotion and behavior in individuals who either carried a low (L) or high (H) activity MAOA variant. Testosterone administration increased provocation-related self-reported anger and abolished the association between trait aggression and joystick deflection in the frustration block. In MAOA-H carriers endogenous testosterone levels at baseline were associated with increased joystick deflection in both blocks. There was, however, no interaction of testosterone administration and genotype. Although preliminary, the results rather indicate independent influences of exogenous testosterone administration and MAOA, but support an interaction of endogenous testosterone levels and MAOA genetics in a frustration task. The administration of testosterone seems to act on the subjective emotional experience in a provoking situation, while endogenous testosterone levels increased pulling impulses only in carriers of the MAOA-H variant.

Social withdrawal and testosterone levels in early adolescent boys

Social withdrawal may lead to mental health problems and can have a large impact on a life course, particularly among boys. To support adolescents with social withdrawal, an integrative understanding of the biological bases would be helpful. Social dominance, a possible opposite of social withdrawal, is known to have positive associations with testosterone levels. A previous study suggested that social withdrawal has a negative relationship with sexual maturity among adolescent boys. However, the relationship between social withdrawal and testosterone in adolescence is unknown. This study aimed to examine whether social withdrawal was negatively associated with testosterone levels in early adolescent boys. Salivary samples were collected from 159 healthy early adolescent boys (mean age [standard deviation]: 11.5 [0.73]) selected from participants of the "population-neuroscience study of the Tokyo Teen Cohort" (pn-TTC). Social withdrawal and confounding factors, such as the secondary sexual characteristics and their age in months, were evaluated by self-administered questionnaires completed by the primary parents. The degree of social withdrawal was assessed with the Child Behaviour Checklist (CBCL). Levels of salivary testosterone, and cortisol as a control, were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Logistic regression was conducted to examine the association between social withdrawal and testosterone levels. A higher risk of social withdrawal was associated with a lower salivary testosterone level after adjustment for age in months (odds ratio 0.55, 95 % confidence interval 0.33-0.94), and the association remained significant after adjusting for body mass index, the degree of anxiety/depression and pubertal stage. Thus, we found a negative relationship between social withdrawal and testosterone levels in early adolescent boys. These findings may help to clarify the biological foundations of and to develop support for social withdrawal.

Testosterone administration in human social neuroendocrinology: Past, present, and future

Over the past 20 years, social neuroendocrinology researchers have developed pharmacological challenge paradigms to assess the extent to which testosterone plays a causal role in human psychological and behavioural processes. The current paper provides a brief summary of this research and offers recommendations for future research examining the neuroendocrine mechanisms underlying human behaviour.

Endogenous testosterone levels are predictive of symptom reduction with exposure therapy in social anxiety disorder

The Hypothalamus-Pituitary-Gonadal (HPG)-axis, and testosterone in particular, play an important role in social motivational behavior. Socially avoidant behavior, characteristic of social anxiety disorder (SAD), has been linked to low endogenous testosterone levels, and can be alleviated by testosterone administration in SAD. Although these beneficial effects of testosterone may translate to exposure therapy, it remains unknown whether testosterone increases prior to exposure improve therapy outcomes. In this proof-of-principle study, we tested whether pre-exposure (reactive and baseline) endogenous testosterone levels were predictive of exposure outcome in SAD. Seventy-three participants (52 females) with a principal SAD diagnosis performed four speech exposures: three during one standardized exposure therapy session and one at post-assessment one week later. Subjective fear levels were assessed before and after each speech exposure and social anxiety symptoms were assessed at pre- and post-treatment. Pre-treatment testosterone levels were assessed before (baseline) and in response to a pre-exposure instruction session (reactive). Pre-treatment testosterone levels were not related to fear levels during exposure therapy, but predicted pre- to post-treatment reductions in social anxiety symptom severity. Specifically, low baseline and high reactive pre-treatment testosterone levels were associated with larger reductions in social anxiety symptom severity. These findings support the role of HPG-axis in social fear reduction. Specifically, our finding that high reactive testosterone as well as low baseline testosterone predicted exposure outcome in SAD, suggests that good reactivity of the HPG-axis is a promising marker for the symptom-reducing effects of exposure therapy.

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

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

Trait and state patterns of basolateral amygdala connectivity at rest are related to endogenous testosterone and aggression in healthy young women

The steroid hormone testosterone (T) has been suggested to influence reactive aggression upon its action on the basolateral amygdala (BLA), a key brain region for threat detection. However, it is unclear whether T modulates resting-state functional connectivity (rsFC) of the BLA, and whether this predicts subsequent aggressive behavior. Aggressive interactions themselves, which often induce changes in T concentrations, could further alter BLA rsFC, but this too remains untested. Here we investigated the effect of endogenous T on rsFC of the BLA at baseline as well as after an aggressive encounter, and whether this was related to behavioral aggression in healthy young women (n = 39). Pre-scan T was negatively correlated with basal rsFC between BLA and left superior temporal gyrus (STG; p < .001, p < .05 Family-Wise Error [FWE] cluster-level corrected), which in turn was associated with increased aggression (r = .37, p = .020). BLA-STG coupling at rest might thus underlie hostile readiness in low-T women. In addition, connectivity between the BLA and the right superior parietal lobule (SPL), a brain region involved in higher-order perceptual processes, was reduced in aggressive participants (p < .001, p < .05 FWE cluster-level corrected). On the other hand, post-task increases in rsFC between BLA and medial orbitofrontal cortex (mOFC) were linked to reduced aggression (r = -.36, p = .023), consistent with the established notion that the mOFC regulates amygdala activity in order to curb aggressive impulses. Finally, competition-induced changes in T were associated with increased coupling between the BLA and the right lateral OFC (p < .001, p < .05 FWE cluster-level corrected), but this effect was unrelated to aggression. We thus identified connectivity patterns that prospectively predict aggression in women, and showed how aggressive interactions in turn impact these neural systems.

Social anxiety and sensitivity to social-rank features in male faces

BACKGROUND AND OBJECTIVES

Evolutionary theories propose that socially anxious individuals are especially sensitive to social-rank signals, presumably at the expense of the attunement to signals of affiliation. Despite this theoretical claim, few empirical attempts examined the association between social anxiety (SA) and sensitivity to specific features of social-rank and affiliation. This study aims to fill this gap.

METHOD

Participants (N = 67) completed two tasks in which two emotionally neutral computer-generated male faces of the same character were presented side-by-side. In the Social-Rank-Sensitivity Task, the faces within each pair differed in their level of dominance and, in the Affiliation-Sensitivity Task, the faces differed in their level of trustworthiness. The participants' task was to decide which of the two faces looked more dominant or friendly.

RESULTS

There were no differences in accuracy between high- and low-SA participants in the Affiliation-Sensitivity Task. In contrast, high-SA participants were more accurate than low-SA participants in the Social-Rank-Sensitivity Task. No group differences were found in decision latencies in either task.

LIMITATIONS

Limitations of the study are that a non-clinical sample was used and that only computer-generated male faces were considered.

CONCLUSIONS

Our findings suggest that SA is related to an enhanced ability to discriminate faces based on social-rank features. Examining sensitivity to facial cues signaling social-rank and affiliation may help to specify the nature of social threat sensitivity in SA.

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.

Human social neuroendocrinology: Review of the rapid effects of testosterone

Contribution to Special Issue on Fast effects of steroids. It is well documented that testosterone concentrations change rapidly within reproductively relevant contexts (e.g., competition, mate-seeking). It has been argued that such rapid changes in testosterone may serve to adaptively fine-tune ongoing and/or future social behaviour according to one's social environment. In this paper, we review human correlational and experimental evidence suggesting that testosterone fluctuates rapidly in response to competition and mate-seeking cues, and that such acute changes may serve to modulate ongoing and/or future social behaviours (e.g., risk-taking, competitiveness, mate-seeking, and aggression). Some methodological details, which limit interpretation of some of this human work, are also discussed. We conclude with a new integrative model of testosterone secretion and behaviour, the Fitness Model of Testosterone Dynamics. Although we focus primarily on human aggression in this review, we also highlight research on risk-taking, competitiveness, and mate-seeking behaviour.

Neural correlates of emotional action control in anger-prone women with borderline personality disorder

BACKGROUND

Difficulty in controlling emotional impulses is a crucial component of borderline personality disorder (BPD) that often leads to destructive, impulsive behaviours against others. In line with recent findings in aggressive individuals, deficits in prefrontal amygdala coupling during emotional action control may account for these symptoms.

METHODS

To study the neurobiological correlates of altered emotional action control in individuals with BPD, we asked medication-free, anger-prone, female patients with BPD and age- and intelligence-matched healthy women to take part in an approach-avoidance task while lying in an MRI scanner. The task required controlling fast behavioural tendencies to approach happy and avoid angry faces. Additionally, before the task we collected saliva testosterone and self-reported information on tendencies to act out anger and correlated this with behavioural and functional MRI (fMRI) data.

RESULTS

We included 30 patients and 28 controls in our analysis. Patients with BPD reported increased tendencies to act out anger and were faster in approaching than avoiding angry faces than with healthy women, suggesting deficits in emotional action control in women with BPD. On a neural level, controlling fast emotional action tendencies was associated with enhanced activation in the antero- and dorsolateral prefrontal cortex across groups. Healthy women showed a negative coupling between the left dorsolateral prefrontal cortex and right amygdala, whereas this was absent in patients with BPD.

LIMITATIONS

Specificity of results to BPD and sex differences remain unknown owing to the lack of clinical control groups and male participants.

CONCLUSION

The results indicate reduced lateral prefrontal-amygdala communication during emotional action control in anger-prone women with BPD. The findings provide a possible neural mechanism underlying difficulties with controlling emotional impulses in patients with BPD.

A randomized controlled study of power posing before public speaking exposure for social anxiety disorder: No evidence for augmentative effects

This manuscript details a randomized controlled study designed to test the efficacy of power posing (i.e., briefly holding postures associated with dominance and power) as an augmentative strategy for exposure therapy for social anxiety disorder (SAD). Seventy-three individuals diagnosed with SAD were assigned to one of three conditions: power posing, submissive posing, or rest (no posing) prior to participating in an exposure therapy session. Participants were assessed for between-group differences in pre- and post-manipulation salivary hormone levels, within-session subjective experiences of fear, and pre- and 1-week post-treatment SAD severity outcome measures. Though the intervention resulted in decreased SAD symptom severity one week later, analyses revealed no significant between-group differences on any tested variables. Accordingly, this study provides no evidence to suggest that power posing impacts hormone levels or exposure therapy outcomes.

Functional significance of men's testosterone reactivity to social stimuli

Rapid testosterone fluctuations in response to social stimuli are observed across a wide range of species, and the highly conserved nature of these fluctuations suggests an adaptive function. This paper reviews the current literature on testosterone reactivity, primarily in human males, and illustrates how life-history theory provides an adequate theoretical framework to interpret findings. The review is structured around supporting evidence suggesting that situations implicated in mating effort either directly (e.g., interactions with a mate) or indirectly (e.g., intrasexual competition) are generally associated with a brief elevation of testosterone, while situations implicated in parenting effort (e.g., nurturant interactions with offspring) are generally associated with a decline in testosterone. Further, we discuss how these fluctuations in testosterone have been linked to future behaviors, and how situational, motivational, and physiological variables moderate the interplay between social stimuli, testosterone reactivity, and behavior. Supporting the notion that testosterone can play a causal role in modulating behavior in response to social stimuli, we also summarize recent single administration studies examining the effects of testosterone on physiology, neurobiology, and behavior. A conceptual model provides links between supported findings, and hypothesized pathways requiring future testing.

Testosterone during Puberty Shifts Emotional Control from Pulvinar to Anterior Prefrontal Cortex

Increased limbic and striatal activation in adolescence has been attributed to a relative delay in the maturation of prefrontal areas, resulting in the increase of impulsive reward-seeking behaviors that are often observed during puberty. However, it remains unclear whether and how this general developmental pattern applies to the control of social emotional actions, a fundamental adult skill refined during adolescence. This domain of control pertains to decisions involving emotional responses. When faced with a social emotional challenge (e.g., an angry face), we can follow automatic response tendencies and avoid the challenge or exert control over those tendencies by selecting an alternative action. Using an fMRI-adapted social approach-avoidance task, this study identifies how the neural regulation of emotional action control changes as a function of human pubertal development in 14-year-old adolescents (n = 47). Pubertal maturation, indexed by testosterone levels, shifted neural regulation of emotional actions from the pulvinar nucleus of the thalamus and the amygdala to the anterior prefrontal cortex (aPFC). Adolescents with more advanced pubertal maturation showed greater aPFC activity when controlling their emotional action tendencies, reproducing the same pattern consistently observed in adults. In contrast, adolescents of the same age, but with less advanced pubertal maturation, showed greater pulvinar and amygdala activity when exerting similarly effective emotional control. These findings qualify how, in the domain of social emotional actions, executive control shifts from subcortical to prefrontal structures during pubertal development. The pulvinar and the amygdala are suggested as the ontogenetic precursors of the mature control system centered on the anterior prefrontal cortex.

SIGNIFICANCE STATEMENT

Adolescents can show distinct behavioral problems when emotionally aroused. This could be related to later development of frontal regions compared with deeper brain structures. This study found that when the control of emotional actions needs to be exerted, more mature adolescents, similar to adults, recruit the anterior prefrontal cortex (aPFC). Less mature adolescents recruit specific subcortical regions, namely the pulvinar and amygdala. These findings identify the subcortical pulvino-amygdalar pathway as a relevant precursor of a mature aPFC emotional control system, opening the way for a neurobiological understanding of how emotion control-related disorders emerge during puberty.

Exogenous testosterone decreases men's personal distance in a social threat context

BACKGROUND

Testosterone can motivate human approach and avoidance behavior. Specifically, the conscious recognition of and implicit reaction to angry facial expressions is influenced by testosterone. The study tested whether exogenous testosterone modulates the personal distance (PD) humans prefer in a social threat context.

METHODS

82 healthy male participants underwent either transdermal testosterone (testosterone group) or placebo application (placebo group). Each participant performed a computerized stop-distance task before (T1) and 3.5h after (T2) treatment, during which they indicated how closely they would approach a human, animal or virtual character with varying emotional expression.

RESULTS

Men's PD towards humans and animals varied as a function of their emotional expression. In the testosterone group, a pre-post comparison indicated that the administration of 50mg testosterone was associated with a small but significant reduction of men's PD towards aggressive individuals. Men in the placebo group did not change the initially chosen PD after placebo application independent of the condition. However comparing the testosterone and placebo group after testosterone administration did not reveal significant differences. While the behavioral effect was small and only observed as within-group effect it was repeatedly and selectively shown for men's PD choices towards an angry woman, angry man and angry dog in the testosterone group. In line with the literature, our findings in young men support the influential role of exogenous testosterone on male's approach behavior during social confrontations.

Testosterone abolishes implicit subordination in social anxiety

Neuro-evolutionary theories describe social anxiety as habitual subordinate tendencies acquired through a recursive cycle of social defeat and submissive reactions. If so, the steroid hormone testosterone might be of therapeutic value, as testosterone is a main force behind implicit dominance drive in many species including humans. We combined these two theories to investigate whether the tendency to submit to the dominance of others is an implicit mechanism in social anxiety (Study-1), and whether this can be relieved through testosterone administration (Study-2). Using interactive eye-tracking we demonstrate that socially anxious humans more rapidly avert gaze from subliminal angry eye contact (Study-1). We replicate this effect of implicit subordination in social anxiety in an independent sample, which is subsequently completely abolished after a single placebo-controlled sublingual testosterone administration (Study-2). These findings provide crucial evidence for hormonal and behavioral treatment strategies that specifically target mechanisms of dominance and subordination in social anxiety.