All eyes on me?! Social anxiety and self-directed perception of eye gaze

Variations in the Appearance and Interpretation of Interpersonal Eye Contact in Social Categorizations and Psychiatric Populations Worldwide: A Scoping Review with a Critical Appraisal of the Literature

BACKGROUND

Eye contact is one of the most fundamental forms of interhuman communication. However, to date, there has been no comprehensive research comparing how eye contact is made and interpreted in all possible populations worldwide. This study presents a summary of the existing literature on these modalities stratified to social categorizations and psychiatric disorders.

METHOD

A scoping review with critical appraisal of the literature according to the Joanna Briggs Institute (JBI) methodology. Databases AnthroSource, Medline, CINAHL, the Psychology and Behavioral Sciences Collection (EBSCO) and PsychInfo were searched.

RESULTS

7068 articles were screened for both the grey literature and reference lists, of which 385 were included, 282 for social categorizations and 103 for psychiatric disorders. In total, 603 thematic clustered outcomes of variations were included. Methodological quality was generally moderate to good.

CONCLUSIONS

There is a great degree of variation in the presentation and interpretation of eye contact between and within populations. It remains unclear why specific variations occur in populations. Additionally, no gold standard for how eye contact should be used or interpreted emerged from the studies. Further research into the reason for differences in eye contact between and within populations is recommended.

Influence of autistic traits and communication role on eye contact behavior during face-to-face interaction

Eye contact is a central component in face-to-face interactions. It is important in structuring communicative exchanges and offers critical insights into others' interests and intentions. To better understand eye contact in face-to-face interactions, we applied a novel, non-intrusive deep-learning-based dual-camera system and investigated associations between eye contact and autistic traits as well as self-reported eye contact discomfort during a referential communication task, where participants and the experimenter had to guess, in turn, a word known by the other individual. Corroborating previous research, we found that participants' eye gaze and mutual eye contact were inversely related to autistic traits. In addition, our findings revealed different behaviors depending on the role in the dyad: listening and guessing were associated with increased eye contact compared with describing words. In the listening and guessing condition, only a subgroup who reported eye contact discomfort had a lower amount of eye gaze and eye contact. When describing words, higher autistic traits were associated with reduced eye gaze and eye contact. Our data indicate that eye contact is inversely associated with autistic traits when describing words, and that eye gaze is modulated by the communicative role in a conversation.

The integration of head and body cues during the perception of social interactions

Humans spend a large proportion of time participating in social interactions. The ability to accurately detect and respond to human interactions is vital for social functioning, from early childhood through to older adulthood. This detection ability arguably relies on integrating sensory information from the interactants. Within the visual modality, directional information from a person's eyes, head, and body are integrated to inform where another person is looking and who they are interacting with. To date, social cue integration research has focused largely on the perception of isolated individuals. Across two experiments, we investigated whether observers integrate body information with head information when determining whether two people are interacting, and manipulated frame of reference (one of the interactants facing observer vs. facing away from observer) and the eye-region visibility of the interactant. Results demonstrate that individuals integrate information from the body with head information when perceiving dyadic interactions, and that integration is influenced by the frame of reference and visibility of the eye-region. Interestingly, self-reported autistics traits were associated with a stronger influence of body information on interaction perception, but only when the eye-region was visible. This study investigated the recognition of dyadic interactions using whole-body stimuli while manipulating eye visibility and frame of reference, and provides crucial insights into social cue integration, as well as how autistic traits affect cue integration, during perception of social interactions.

No evidence that gaze anxiety predicts gaze avoidance behavior during face-to-face social interaction

Eye contact is an indispensable social signal, yet for some individuals it is also a source of discomfort they fear and avoid. However, it is still unknown whether gaze anxiety actually produces avoidant gaze behavior in naturalistic, face-to-face interactions. Here, we relied on a novel dual eye-tracking setup that allows us to assess interactive gaze behavior. To investigate the effect of gaze anxiety on gaze behavior, we a priori created groups of participants reporting high or low levels of gaze anxiety. These participants (n = 51) then performed a semi-standardized interaction with a previously unknown individual reporting a medium level of gaze anxiety. The gaze behavior of both groups did not differ in either classical one-way, eye-tracking parameters (e.g. unilateral eye gaze), or interactive, two-way ones (e.g. mutual gaze). Furthermore, the subjective ratings of both participants' interaction did not differ between groups. Gaze anxious individuals seem to exhibit normal gaze behavior which does not hamper the perceived quality of interactions in a naturalistic face-to-face setup. Our findings point to the existence of cognitive distortions in gaze anxious individuals whose exterior behavior might be less affected than feared by their interior anxiety.

Perception of eye contact, self-referential thinking and age

Increased thinking about one's self has been proposed to widen the gaze cone, that is, the range of gaze deviations that an observer judges as looking directly at them (eye contact). This study investigated the effects of a self-referential thinking manipulation and demographic factors on the gaze cone. In a preregistered experiment (N = 200), the self-referential thinking manipulation, as compared to a control manipulation, did not influence the gaze cone, or the use of first-person pronouns in a manipulation check measuring self-referential processing. This may indicate a failure of the manipulation and participants' lack of effort. However, participants' age was significantly correlated with both measures: older people had wider gaze cones and used more self-referring pronouns. A second experiment (N = 300) further examined the effect of the manipulation and demographic factors on self-referential processing, and the results were replicated. These findings may reflect age-related self-reference and positivity effects.

Representations of facial expressions since Darwin

Darwin's book on expressions of emotion was one of the first publications to include photographs (Darwin, The expression of the emotions in Man and animals, 1872). The inclusion of expression photographs meant that readers could form their own opinions and could, like Darwin, survey others for their interpretations. As such, the images provided an evidence base and an 'open source'. Since Darwin, increases in the representativeness and realism of emotional expressions have come from the use of composite images, colour, multiple views and dynamic displays. Research on understanding emotional expressions has been aided by the use of computer graphics to interpolate parametrically between different expressions and to extrapolate exaggerations. This review tracks the developments in how emotions are illustrated and studied and considers where to go next.

The Cone of Direct Gaze: A Stable Trait

Direct eye gaze is a potent stimulus in social interactions and is often associated with interest and approach orientation. Yet, there is remarkable variability in the range of gaze lines that people accept as being direct. A measure that is frequently used to quantify the range of gaze angles within which an observer assumes mutual gaze is the cone of direct gaze (CoDG). While individual differences in CoDG have often been examined, studies that systematically investigate the stability of an observers' CoDG over time are scarce. In two experiments, we measured the CoDG using an established paradigm and repeated the measurement after 5 min and/or after 1 week. We found high inter-individual variation, but high agreement within participants (ICCs between 0.649 and 0.855). We conclude that the CoDG can be seen as a rather stable measure, much like a personality trait.

Dynamic causal modeling of eye gaze processing in schizophrenia

BACKGROUND

Abnormal eye gaze perception is related to symptoms and social functioning in schizophrenia. However, little is known about the brain network mechanisms underlying these abnormalities. Here, we employed dynamic causal modeling (DCM) of fMRI data to discover aberrant effective connectivity within networks associated with eye gaze processing in schizophrenia.

METHODS

Twenty-seven patients (schizophrenia/schizoaffective disorder, SZ) and 22 healthy controls (HC) completed an eye gaze processing task during fMRI. Participants viewed faces with different gaze angles and performed explicit gaze discrimination (Gaze: "Looking at you?" yes/no) or implicit gaze processing (Gender: "male or female?"). Four brain regions, the secondary visual cortex (Vis), posterior superior temporal sulcus (pSTS), inferior parietal lobule (IPL), and posterior medial frontal cortex (pMFC) were identified as nodes for subsequent DCM analysis.

RESULTS

SZ and HC showed similar generative model structure, but SZ showed altered connectivity for specific self-connections, inter-regional connections during all gaze processing (reduced excitatory bottom-up and enhanced inhibitory top-down connections), and modulation by explicit gaze discrimination (increased frontal inhibition of visual cortex). Altered effective connectivity was significantly associated with poorer social cognition and functioning.

CONCLUSIONS

General gaze processing in SZ is associated with distributed cortical dysfunctions and bidirectional connectivity between regions, while explicit gaze discrimination involves predominantly top-down abnormalities in the visual system. These results suggest plausible neural mechanisms underpinning gaze processing deficits and may serve as bio-markers for intervention.

Deconstructing eye contact perception: Measuring perceptual precision and self-referential tendency using an online psychophysical eye contact detection task

Eye contact perception—the ability to accurately and efficiently discriminate others’ gaze directions—is critical to understanding others and functioning in a complex social world. Previous research shows that it is affected in multiple neuropsychiatric disorders accompanied by social dysfunction, and understanding the cognitive processes giving rise to eye contact perception would help advance mechanistic investigations of psychopathology. This study aims to validate an online, psychophysical eye contact detection task through which two constituent cognitive components of eye contact perception (perceptual precision and self-referential tendency) can be derived. Data collected from a large online sample showed excellent test-retest reliability for self-referential tendency and moderate reliability for perceptual precision. Convergence validity was supported by correlations with social cognitive measures tapping into different aspects of understanding others. Hierarchical regression analyses revealed that perceptual precision and self-referential tendency explained unique variance in social cognition, suggesting that they measure unique aspects of related constructs. Overall, this study provided support for the reliability and validity of the eye contact perception metrics derived using the online Eye Contact Detection Task. The value of the task for future psychopathology research was discussed.

Theta resting EEG in TPJ/pSTS is associated with individual differences in the feeling of being looked at

Direct eye gaze is a powerful stimulus in social interactions, yet people vary considerably in the range of gaze lines that they accept as being direct (cone of direct gaze, CoDG). Here, we searched for a possible neural trait marker of these individual differences. We measured the width of the CoDG in 137 healthy participants and related their individual CoDG to their neural baseline activation as measured with resting electroencephalogram. Using a source-localization technique, we found that resting theta current density in the left temporo-parietal junction (TPJ) and adjacent posterior superior temporal sulcus (pSTS) was associated with the width of CoDG. Our findings suggest that the higher the baseline cortical activation in the left TPJ/pSTS, the wider the CoDG and thus the more liberal the individuals’ judgments were in deciding whether a looker stimulus was making eye contact or not. This is a first demonstration of the neural signatures underlying individual differences in the feeling of being looked at.

Socially Anxious Tendencies Affect Impressions of Others' Positive and Negative Emotional Gazes

Socially anxious tendencies have potential to become social anxiety disorder (SAD), which is characterized by fear of social situations associated with being evaluated or embarrassed by others. In particular, others’ gazes induce social anxiety. People with SAD have a negative interpretation bias toward ambiguous emotions in others’ faces; however, negative interpretation bias toward ambiguous emotions in others’ gazes has not been fully investigated. We used an impression judgment task to examine negative interpretation bias toward others’ gazes among people with socially anxious tendencies. We generated emotionally ambiguous gazes (positive, negative, and neutral) using a morphing technique with 10% steps (neutral, 10–100% negative, and 10–100% positive). Participants (all male) were asked to judge whether the stimulus was positive or negative. Each participant’s level of social anxiety was examined using the Japanese version of the Social Phobia Inventory (SPIN-J), which measures three symptom dimensions: fear, avoidance, and physiological arousal. To examine the influence of socially anxious tendencies in the impression judgment task, we calculated the point of subjective equality (PSE) using a two-step logistic curve fitted to individual participant’s responses. The negative emotional intensity of the PSE became lower as the fear score became higher (p < 0.05). This result suggests individuals with a high tendency toward social anxiety tend to interpret subtle negative emotional gazes as a negative emotion and regard these gazes as a threat.

I don't need your attention: ostracism can narrow the cone of gaze

Previous research has shown that ostracized participants seek inclusive cues, such as gaze directed at them, when trying to reaffiliate. However, instead of seeking reinclusion, ostracized individuals may sometimes withdraw from interactions if not offered an opportunity for reaffiliation. In the current study, after an ostracism manipulation with no reaffiliation opportunity, participants judged whether faces portraying direct gaze or slightly averted gaze (2°-8° to the left and to the right) were looking at them or not. Compared to an inclusion group and a non-social control group, ostracized participants accepted a smaller range of gaze directions as being directed at them, i.e., they had a narrower "cone of gaze". The width of the gaze cone was equally wide in the inclusion and control groups. We propose that, without an opportunity for reaffiliation, ostracized participants may start to view other people as particularly unapproachable, possibly indicative of a motivational tendency to disengage from interactions.

Trypophobia: What Do We Know So Far? A Case Report and Comprehensive Review of the Literature

In this article, we describe the case of a girl who suffers from a phobia to repetitive patterns, known as trypophobia. This condition has not yet been recognised by diagnostic taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. Trypophobia usually involves an intense and disproportionate fear towards holes, repetitive patterns, protrusions, etc., and, in general, images that present high-contrast energy at low and midrange spatial frequencies. It is commonly accompanied by neurovegetative symptoms. In the case we present here, the patient also suffered from generalised anxiety disorder and was treated with sertraline. After she was diagnosed, she showed symptoms of both fear and disgust towards trypophobic images. After some time following treatment, she only showed disgust towards said images. We finish this case report presenting a comprehensive literature review of the peer reviewed articles we retrieved after an exhaustive search about trypophobia, we discuss how this case report contributes to the understanding of this anxiety disorder, and what questions future studies should address in order to achieve a better understanding of trypophobia.

Trait Anxiety Impacts the Perceived Gaze Direction of Fearful But Not Angry Faces

Facial expression and gaze direction play an important role in social communication. Previous research has demonstrated the perception of anger is enhanced by direct gaze, whereas, it is unclear whether perception of fear is enhanced by averted gaze. In addition, previous research has shown the anxiety affects the processing of facial expression and gaze direction, but hasn't measured or controlled for depression. As a result, firm conclusions cannot be made regarding the impact of individual differences in anxiety and depression on perceptions of face expressions and gaze direction. The current study attempted to reexamine the effect of the anxiety level on the processing of facial expressions and gaze direction by matching participants on depression scores. A reliable psychophysical index of the range of eye gaze angles judged as being directed at oneself [the cone of direct gaze (CoDG)] was used as the dependent variable in this study. Participants were stratified into high/low trait anxiety groups and asked to judge the gaze of angry, fearful, and neutral faces across a range of gaze directions. The result showed: (1) the perception of gaze direction was influenced by facial expression and this was modulated by trait anxiety. For the high trait anxiety group, the CoDG for angry expressions was wider than for fearful and neutral expressions, and no significant difference emerged between fearful and neutral expressions; For the low trait anxiety group, the CoDG for both angry and fearful expressions was wider than for neutral, and no significant difference emerged between angry and fearful expressions. (2) Trait anxiety modulated the perception of gaze direction only in the fearful condition, such that the fearful CoDG for the high trait anxiety group was narrower than the low trait anxiety group. This demonstrated that anxiety distinctly affected gaze perception in expressions that convey threat (angry, fearful), such that a high trait anxiety level modulated the impact of indirectly threatening expressions (fearful), and did not influence responses to directly threatening expression (angry). These findings partially support the shared signal hypothesis.

The effects of social pressure and emotional expression on the cone of gaze in patients with social anxiety disorder

BACKGROUND AND OBJECTIVES

Patients with social anxiety disorder suffer from pronounced fears in social situations. As gaze perception is crucial in these situations, we examined which factors influence the range of gaze directions where mutual gaze is experienced (the cone of gaze).

METHODS

The social stimulus was modified by changing the number of people (heads) present and the emotional expression of their faces. Participants completed a psychophysical task, in which they had to adjust the eyes of a virtual head to gaze at the edge of the range where mutual eye-contact was experienced.

RESULTS

The number of heads affected the width of the gaze cone: the more heads, the wider the gaze cone. The emotional expression of the virtual head had no consistent effect on the width of the gaze cone, it did however affect the emotional state of the participants. Angry expressions produced the highest arousal values. Highest valence emerged from happy faces, lowest valence from angry faces.

CONCLUSION

These results suggest that the widening of the gaze cone in social anxiety disorder is not primarily mediated by their altered emotional reactivity. Implications for gaze assessment and gaze training in therapeutic contexts are discussed.

LIMITATIONS

Due to interindividual variability, enlarged gaze cones are not necessarily indicative of social anxiety disorder, they merely constitute a correlate at the group level.

Eye Contact Judgment Is Influenced by Perceivers' Social Anxiety But Not by Their Affective State

Fast and accurate judgment of whether another person is making eye contact or not is crucial for our social interaction. As affective states have been shown to influence social perceptions and judgments, we investigated the influence of observers’ own affective states and trait anxiety on their eye contact judgments. In two experiments, participants were required to judge whether animated faces (Experiment 1) and real faces (Experiment 2) with varying gaze angles were looking at them or not. Participants performed the task in pleasant, neutral, and unpleasant odor conditions. The results from two experiments showed that eye contact judgments were not modulated by observers’ affective state, yet participants with higher levels of social anxiety accepted a wider range of gaze deviations from the direct gaze as eye contact. We conclude that gaze direction judgments depend on individual differences in affective predispositions, yet they are not amenable to situational affective influences.

An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder

Social Anxiety Disorder (SAD) commonly co-occurs with, and often precedes, Alcohol Use Disorder (AUD). In this paper, we address the relationship between SAD and AUD by considering how natural selection left socially anxious individuals vulnerable to alcohol use, and by addressing the underlying mechanisms. We review research suggesting that social anxiety has evolved for the regulation of behaviors involved in reducing the likelihood or consequences of threats to social status. The management of potential threats to social standing is important considering that these threats can result in reduced cooperation or ostracism - and therefore to reduced access to coalitional partners, resources or mates. Alcohol exerts effects upon evolutionarily conserved emotion circuits, and can down-regulate or block anxiety (or may be expected to do so). As such, the ingestion of alcohol can artificially signal the absence or successful management of social threats. In turn, alcohol use may be reinforced in socially anxious people because of this reduction in subjective malaise, and because it facilitates social behaviors - particularly in individuals for whom the persistent avoidance of social situations poses its own threat (i.e., difficulty finding mates). Although the frequent co-occurrence of SAD and AUD is associated with poorer treatment outcomes than either condition alone, a richer understanding of the biological and psychosocial drives underlying susceptibility to alcohol use among socially anxious individuals may improve the efficacy of therapeutic interventions aimed at preventing or treating this comorbidity.

Altered Visual Adaptation to Body Shape in Eating Disorders: Implications for Body Image Distortion

Previous research has shown that after adapting to a thin body, healthy participants (HP) perceive pictures of their own bodies as being fatter and vice versa. This aftereffect might contribute to the development of perceptual body image disturbances in eating disorders (ED).In the present study, HP and ED completed a behavioral experiment to rate manipulated pictures of their own bodies after adaptation to thin or fat body pictures. After adapting to a thin body, HP judged a thinner than actual body picture to be the most realistic and vice versa, resembling a typical aftereffect. ED only showed such an adaptation effect when they adapted to fat body pictures.The reported results indicate a relationship between body image distortion in ED and visual body image adaptation. It can be suspected that due to a pre-existing, long-lasting adaptation to thin body shapes in ED, an additional visual adaption to thin body shapes cannot be induced. Hence this pre-existing adaptation to thin body shapes could induce perceptual body image distortions in ED.

Eye contact perception in the West and East: a cross-cultural study

This study investigated whether eye contact perception differs in people with different cultural backgrounds. Finnish (European) and Japanese (East Asian) participants were asked to determine whether Finnish and Japanese neutral faces with various gaze directions were looking at them. Further, participants rated the face stimuli for emotion and other affect-related dimensions. The results indicated that Finnish viewers had a smaller bias toward judging slightly averted gazes as directed at them when judging Finnish rather than Japanese faces, while the bias of Japanese viewers did not differ between faces from their own and other cultural backgrounds. This may be explained by Westerners experiencing more eye contact in their daily life leading to larger visual experience of gaze perception generally, and to more accurate perception of eye contact with people from their own cultural background particularly. The results also revealed cultural differences in the perception of emotion from neutral faces that could also contribute to the bias in eye contact perception.

Gaze perception in social anxiety and social anxiety disorder

Clinical observations suggest abnormal gaze perception to be an important indicator of social anxiety disorder (SAD). Experimental research has yet paid relatively little attention to the study of gaze perception in SAD. In this article we first discuss gaze perception in healthy human beings before reviewing self-referential and threat-related biases of gaze perception in clinical and non-clinical socially anxious samples. Relative to controls, socially anxious individuals exhibit an enhanced self-directed perception of gaze directions and demonstrate a pronounced fear of direct eye contact, though findings are less consistent regarding the avoidance of mutual gaze in SAD. Prospects for future research and clinical implications are discussed.

Cone of direct gaze as a marker of social anxiety in males

The fear of being scrutinised is a core feature of social anxiety disorder and socially anxious individuals overestimate being 'looked at'. A recent development in the vision sciences is a reliable psychophysical index of the range of eye gaze angles judged as being directed at oneself (Cone of Direct Gaze: CoDG). We tested the CoDG as a measure of "being looked at" in social anxiety. Participants were stratified into high/low social anxiety groups and asked to judge whether they were being 'looked at' by computerised male faces varying in eye gaze deviation and facial emotion. High socially anxious males had a wider CoDG than low socially anxious males; high and low socially anxious females did not differ. Fearful faces elicited narrower cones than neutral or angry faces; however, the effect size was small and not evident for the high socially anxious males. Measures of subjective reactions to the study, and to being looked at in general, indicated that the results may be in part due to males suffering more discomfort when being looked at. The results show that measures derived from psychophysics, in this case, the CoDG, have potential as clinical and research tools for measuring anxiety about being scrutinised.