Heightened sensitivity to emotional expressions in generalised anxiety disorder, compared to social anxiety disorder, and controls

The effect of anxiety and its interplay with social cues when perceiving aggressive behaviours

Contextual cues and emotional states carry expectations and biases that are used to attribute meaning to what we see. In addition, emotional states, such as anxiety, shape our visual systems, increasing overall, and particularly threat-related, sensitivity. It remains unclear, however, how anxiety interacts with additional cues when categorising sensory input. This is especially important in social scenarios where ambiguous gestures are commonplace, thus requiring the integration of cues for a proper interpretation. To this end, we decided to assess how states of anxiety might bias the perception of potentially aggressive social interactions, and how external cues are incorporated in this process. Participants (N = 71) were tasked with signalling the presence of aggression in ambiguous social interactions. Simultaneously, an observer (facial expression) reacted (by showing an emotional expression) to this interaction. Importantly, participants performed this task under safety and threat of shock conditions. Decision measures and eye-tracking data were collected. Our results showed that threat of shock did not affect sensitivity nor criterion when detecting aggressive interactions. The same pattern was observed for response times. Drift diffusion modelling analysis, however, suggested quicker evidence accumulation when under threat. Finally, dwell times over the observer were higher when under threat, indicating a possible association between anxiety states and a bias towards potentially threat-related indicators. Future probing into this topic remains a necessity to better explain the current findings.

Relationship between types of anxiety and the ability to recognize facial expressions

This study examined whether three subtypes of anxiety (trait anxiety, state anxiety, and social anxiety) have different effects on recognition of facial expressions. One hundred and thirty-eight participants matched facial expressions of three intensity levels (20 %, 40 %, 100 %) with one of the six emotion labels ("happy", "sad", "fear", "angry", "disgust", and "surprise"). While using a conventional method of analysis we were able to replicate some significant correlations between each anxiety type and recognition performance found in the literature. However, when we used partial correlation to isolate the effect of each anxiety type, most of these correlations were no longer significant, apart from the negative correlations between Beck Anxiety Inventory and reaction time to fearful faces displayed at 40 % intensity level, and the correlations between anxiety and categorisation errors. Specifically, social anxiety was positively correlated with misidentifying a happy face as a disgust face at 40 % intensity level, and state anxiety negatively correlated with misidentifying a happy face as a sad face at 20 % intensity level. However, these partial correlation analyses became non-significant after p value adjustment for multiple comparisons. Our eye tracking data also showed that state anxiety may be associated with reduced fixations on the eye regions of low-intensity sad or fearful faces. These analyses cast doubts on some effects reported in the previous studies because they are likely to reflect a mixture of influences from highly correlated anxiety subtypes.

Facial mimicry and metacognitive judgments in emotion recognition are distinctly modulated by social anxiety and autistic traits

Facial mimicry as well as the accurate assessment of one's performance when judging others' emotional expressions have been suggested to inform successful emotion recognition. Differences in the integration of these two information sources might explain alterations in the perception of others' emotions in individuals with Social Anxiety Disorder and individuals on the autism spectrum. Using a non-clinical sample (N = 57), we examined the role of social anxiety and autistic traits in the link between facial mimicry, or confidence in one's performance, and emotion recognition. While participants were presented with videos of spontaneous emotional facial expressions, we measured their facial muscle activity, asked them to label the expressions and indicate their confidence in accurately labelling the expressions. Our results showed that confidence in emotion recognition was lower with higher social anxiety traits even though actual recognition was not related to social anxiety traits. Higher autistic traits, in contrast, were associated with worse recognition, and a weakened link between facial mimicry and performance. Consequently, high social anxiety traits might not affect emotion recognition itself, but the top-down evaluation of own abilities in emotion recognition contexts. High autistic traits, in contrast, may be related to lower integration of sensorimotor simulations, which promote emotion recognition.

Masking our emotions: Emotion recognition and perceived intensity differ by race and use of medical masks

Although medical masks have played a key role in decreasing the transmission of communicable disease, they simultaneously reduce the availability of nonverbal cues fundamental to social interaction. In the present study, we determined the collective impact of medical masks on emotional expression recognition and perceived intensity as a function of actor race. Participants completed an emotional expression recognition task involving stimuli with or without medical masks. Across six basic emotional facial expressions, medical masks were associated with significantly more emotional expression recognition errors. Overall, the effects associated with race varied depending on the emotion and appearance of masks. Whereas recognition accuracy was higher for White relative to Black actors for anger and sadness, the opposite pattern was observed for disgust. Medical mask-wearing exacerbated actor-race related recognition differences for anger and surprise, but attenuated these differences for fear. Emotional expression intensity ratings were significantly reduced for all emotions except fear, where masks were associated with increased perceived intensity. Masks further increased already higher intensity ratings for anger in Black versus White actors. In contrast, masks eliminated the tendency to give higher intensity ratings for Black versus White sad and happy facial expressions. Overall, our results suggest that the interaction between actor race and mask wearing status with respect to emotional expression judgements is complex, varying by emotion in both direction and degree. We consider the implications of these results particularly in the context of emotionally charged social contexts, such as in conflict, healthcare, and policing.

Facing Uncertainty: Interpretation of Ambiguous Emotional Faces in Childhood Social Anxiety Disorder

OBJECTIVE

The current study examined whether children with a social anxiety disorder (SAD) demonstrate divergent facial emotion processing and a disorder-specific negative interpretation bias in the processing of facial emotional expressions. This study aimed to overcome previous study limitations by including both a nonsocially anxious control group and a healthy control group to examine whether childhood SAD is characterized by a general emotion labeling deficit, and/or by a negative interpretation bias, indicated by systematic misclassifications, or a lower threshold for recognizing threatening emotions.

METHOD

Participants were 132 children aged 7-12 years (M_age = 9.15; 45.5% female). Children with SAD (n = 42) were compared to children with other, nonsocial, anxiety disorders (n = 40) and healthy control children (n = 50) on a novel facial emotion recognition task. Children judged ambiguous happy/neutral, angry/neutral and fear/neutral faces that were morphed at different intensities (10%, 30%, 50%, 70%).

RESULTS

Children with SAD did not differ from other groups in their accuracy of identifying emotions. They did not show systematic misclassifications or a heightened sensitivity to negative, threatening faces either. Rather, children with nonsocial anxiety disorders showed a generally heightened sensitivity to emotional faces.

CONCLUSIONS

The current study does not provide evidence for a general deficit in labeling of emotional faces in childhood SAD. Childhood SAD was not characterized by an interpretation bias in processing emotional faces. Children with nonsocial anxiety disorders may benefit from assistance in accurately interpreting the degree of emotionality in interpersonal situations.

Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts

INTRODUCTION

Generalized anxiety disorder (GAD) is common and disabling. Different versions of cognitive behavioral therapy (CBT) have been tested, but no treatment works for everyone. Therefore, researchers have attempted approaches to enhance CBT.

AREAS COVERED

The current narrative review examines meta-analyses and individual trials of CBT-based treatments for GAD. We focus on CBT and its cognitive and behavioral components as well as efforts to enhance CBT and its dissemination and generalizability. Enhancement efforts included interpersonal and emotional processing therapy, mindfulness-based CBT, emotion regulation therapy, intolerance of uncertainty therapy, the unified protocol, metacognitive therapy, motivational interviewing, and contrast avoidance targeted treatment. Emerging strategies to enhance dissemination have focused on technologically based treatments. Attempts at generalizability have included examination of efficacy within diverse racial and ethnic groups.

EXPERT OPINION

We conclude that CBT is efficacious, and a number of enhancement efforts have shown some promise in improving upon CBT in single trials. However, more research is needed, particularly efforts to determine which enhancements work best for which individuals and what are the mechanisms of change. Furthermore, few technological interventions have been compared to active treatments. Finally, much more attention needs to be paid to ethnic and racial diversity in randomized controlled trials.

Anxiety and threat-related attentional biases in adolescents with fragile X syndrome

BACKGROUND

Fragile X syndrome (FXS) is a single-gene disorder highly associated with anxiety; however, measuring anxiety symptoms in FXS and other neurogenetic syndromes is challenged by common limitations in language, self-awareness and cognitive skills required for many traditional assessment tasks. Prior studies have documented group-level differences in threat-related attentional biases, assessed via eye tracking, in FXS and non-FXS groups. The present study built on this work to test whether attentional biases correspond to clinical features of anxiety among adolescents and young adults with FXS.

METHODS

Participants included 21 male adolescents with FXS ages 15-20 years who completed an adapted eye-tracking task that measured attentional bias towards fearful faces of varied emotional intensity.

RESULTS

Among participants without anxiety disorders, attentional bias towards fear increased across age, similar to non-FXS paediatric anxiety samples. In contrast, participants with anxiety disorders exhibited greater stability in fear-related attentional biases across age. Across analyses, subtle fear stimuli were more sensitive to within-group anxiety variability than full-intensity stimuli.

CONCLUSIONS

Our results provide novel evidence that although threat-related attentional biases may correspond with anxiety outcomes in FXS, these associations are complex and vary across developmental and task factors. Future studies are needed to characterise these associations in more robust longitudinal samples, informing whether and how eye-tracking tasks might be optimised to reliably predict and track anxiety in FXS.

Investigating the Role of Interpretation Bias in Mindfulness-Based Treatment of Adults With Generalized Anxiety Disorder

Although mindfulness-based interventions (MBIs) have garnered empirical support for a wide range of psychological conditions, the psychological processes that mediate the relationship between MBIs and subsequent symptomatic improvement are less well-understood. In the present study we sought to examine, for the first time, the relationship between mindfulness, negative interpretation bias as measured by the homophone task, and anxiety among adults with Generalized Anxiety Disorder (GAD). Forty-two individuals with GAD completed measures of mindfulness, interpretation bias, and anxiety before and after treatment with Mindfulness-based Stress Reduction (MBSR). Contrary to prior research, we did not find evidence of an indirect relationship between baseline levels of mindfulness and anxiety via negative interpretation bias. MBSR did result in significant reductions in negative interpretation bias from baseline to post-treatment; however, we did not find evidence of an indirect relationship between changes in mindfulness and changes in anxiety via changes in interpretation bias. Taken together, these results provide minimal support for the hypothesized relationship between mindfulness, negative interpretation bias, and anxiety among adults with GAD. Limitations and specific suggestions for further inquiry are discussed.

Social anxiety and the interpretation of morphed facial expressions following exclusion and inclusion

BACKGROUND AND OBJECTIVES

Negative interpretation biases are postulated to play etiological and maintaining roles in social anxiety (SA). However, empirical support for interpretation biases of facial expression in SA is inconsistent. Given the importance of signals of (dis)approval in SA, our objective was to examine whether SA is associated with enhanced sensitivity to such signals especially following exclusion.

METHODS

In Study 1, participants (N = 139) underwent an exclusion/inclusion manipulation and were then presented with video clips of smiles gradually changing into disgust expressions (smile-to-disgust). In Study 2 (N = 203), participants saw smile-to-disgust as well as disgust-to-smile clips following an exclusion/inclusion manipulation. Participants' task in both studies was to detect the offset of the initial expression.

RESULTS

Results of Study 1 show that detection latency of smiles' disappearance is negatively associated with SA severity. The results of Study 2 suggest that this association is stronger following exclusion, and specific to the smile-to-disgust as opposed to the disgust-to-smile, transitions.

LIMITATIONS

Our studies did not examine whether the observed interpretation bias was specific to SA.

CONCLUSIONS

Our findings support and refine cognitive theories of SA, suggesting that interpretation biases for facial information in SA may be especially pronounced following exclusion.

Targeting separate specific learning parameters underlying cognitive behavioral therapy can improve perceptual judgments of anger

BACKGROUND AND OBJECTIVES

Anxiety disorders are characterized by biased perceptual judgment. An experimental model using simple verbal instruction to target specific decision parameters that influence perceptual judgment was developed to test if it could influence anger perception, and to examine differences between individuals with social anxiety disorder (SAD) relative to generalized anxiety disorder (GAD) or non-psychiatric controls.

METHODS

Anger perception was decomposed into three decision parameters (perceptual similarity of angry vs. not-angry facial expressions, base rate of encountering angry vs. not-angry expressions, payoff for correct vs. incorrect categorization of face stimuli) using a signal detection framework. Participants with SAD (n = 97), GAD (n = 90), and controls (n = 98) were assigned an instruction condition emphasizing one of the three decision parameters. Anger perception pre-vs. post-instruction and its interaction with diagnosis were examined.

RESULTS

For all participants, base rate instructions impacted response bias over and above practice effects, supporting the validity of this instructional task-based approach to altering response bias. We failed to find a similarity or payoff instruction effect, nor a diagnosis interaction.

LIMITATIONS

Future instructional tasks may need to more closely target core cognitive and perceptual biases in anxiety disorders to identify specific deficits and how to optimally influence them.

CONCLUSIONS

This study demonstrates that specific decision parameters underlying perceptual judgment can be experimentally manipulated. Although our study failed to show diagnosis specific effects, it suggests that individual parameter "estimation" deficits may be experimentally isolated and potentially targeted, with the ultimate goal of developing an objective approach to personalized intervention targeting biased perceptual judgments in anxiety disorders.

Working Memory Maintenance Modulates Serial Dependence Effects of Perceived Emotional Expression

The stability of face perception is vital in interpersonal interactions. Recent studies have revealed the mechanism of the stability in the perception of stable attributes of faces (such as facial identity) by serial dependence, a phenomenon in which perception of current stimuli is pulled toward recently viewed stimuli. However, whether serial dependence of perceived emotional expression (a changeable attribute of faces) exists remains controversial, and its exact nature has not been examined yet. To address these issues, we used the methods of constant stimuli and two-interval forced choice tasks in three psychophysical experiments. Participants compared two successive facial expressions selected from a continuum with 50 morphed faces ranging from sad to happy. Experiment 1a and 1b showed that a perceived facial expression pulled toward previously seen facial expressions (i.e., a significant serial dependence effect), independent of response instructions. Furthermore, a stronger serial dependence effect was found when the first facial expression was retained in working memory for a longer delay duration (Experiment 2), and yet a weaker serial dependence effect was observed when a longer delay between decision and response was performed (Experiment 3). These findings indicate that serial dependence facilitates the stability of facial expression perception and is modulated by working memory representations.

Emotion sensitivity and self-reported symptoms of generalized anxiety disorder across the lifespan: A population-based sample approach

BACKGROUND

Individuals with generalized anxiety disorder (GAD) symptoms show deficits in emotion processing, but results of prior studies have been conflicting, and little is known about developmental trajectories of emotion processing over time. We examined the association between GAD symptoms and sensitivity to recognizing emotional facial expressions (emotion sensitivity: ES) for three emotions (happiness, anger, fear) in a large, diverse, population-based sample. We hypothesized that higher anxiety scores would be associated with poorer performance, and expected that ES performance and anxiety scores would decline across the lifespan.

METHOD

Participants were 7,176 responders to a web-based ES study (age range = 10-96 years old).

RESULTS

Higher GAD-7 scores were associated with poorer ES performance for all emotion categories (happiness, anger, fear). The relationship between GAD-7 and ES scores remained significant after controlling for the effects of age and sex, and there was no significant interaction, indicating that the relationship does not change across age. Age significantly predicted ES and GAD-7 scores across emotions, with older ages showing lower ES scores and lower anxiety.

CONCLUSIONS

In the largest study of its kind, GAD symptoms were associated with impaired ES performance across three emotion types. Future research should explore the connection between anxiety symptoms, cognitive processing, and social processing to better characterize the mechanisms of how GAD is linked with both social and non-social information processing. Future work may also look at if ES is related over time to changes in anxiety, making it a promising target for intervention.

The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: effects on symptoms and comparison with healthy control

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.

Cerebellar Cortex as a Therapeutic Target for Neurostimulation

Non-invasive stimulation of the cerebellum is growingly applied both in the clinic and in research settings to modulate the activities of cerebello-cerebral loops. The anatomical location of the cerebellum, the high responsiveness of the cerebellar cortex to magnetic/electrical stimuli, and the implication of the cerebellum in numerous cerebello-cerebral networks make the cerebellum an ideal target for investigations and therapeutic purposes. In this mini-review, we discuss the potentials of cerebellar neuromodulation in major brain disorders in order to encourage large-scale sham-controlled research and explore this therapeutic aid further.

Worry amplifies theory-of-mind reasoning for negatively valenced social stimuli in generalized anxiety disorder

BACKGROUND

Theory-of-mind (ToM) is the ability to accurately infer others' thoughts and feelings. In generalized anxiety disorder (GAD), cognitive and emotion regulation theories allude to the plausibility that ToM is conditional on the degree of individuals' state worry, a hallmark symptom. GAD and state worry may interact to predict ToM constructs. However, no experiments have directly tested such interactional hypotheses, and used ToM as a framework to advance understanding of social cognition in GAD. This study therefore aimed to address this gap.

METHODS

171 participants (69 GAD, 102 Controls) were randomly assigned to either a Worry or Relaxation induction and completed well-validated ToM decoding (Reading the Mind in the Eyes Test) and reasoning (Movie for the Assessment of Social Cognition) tasks.

RESULTS

GAD status significantly interacted with state worry to predict accuracy of overall reasoning, cognitive-reasoning, positive-reasoning, and negative-reasoning ToM. Worry, as opposed to relaxation, led sufferers of GAD to display more accurate overall reasoning and cognitive-reasoning ToM than controls, especially for negative signals. Participants with GAD who worried, but not relaxed, were also significantly better than the norm at interpreting negative signals. These findings remained after controlling for gender, executive function, social anxiety, and depressive symptoms. For other ToM abilities, mean scores of persons with and without GAD who either worried or relaxed were normative.

LIMITATIONS

The ToM reasoning measure lacked self-reference, and these preliminary findings warrant replication.

CONCLUSIONS

Theoretical implications, such as the state worry-contingent nature of ToM in GAD, and clinical implications are discussed.

Prefrontal and amygdala engagement during emotional reactivity and regulation in generalized anxiety disorder

BACKGROUND

Emotion dysregulation is prominent in generalized anxiety disorder (GAD), characterized clinically by exaggerated reactivity to negative stimuli and difficulty in down-regulating this response. Although limited research implicates frontolimbic disturbances in GAD, whether neural aberrations occur during emotional reactivity, regulation, or both is not well understood.

METHODS

During functional magnetic resonance imaging (fMRI), 30 individuals with GAD and 30 healthy controls (HC) completed a well-validated explicit emotion regulation task designed to measure emotional reactivity and regulation of reactivity. During the task, participants viewed negative images ('Look-Negative' condition) and, on some trials, used a cognitive strategy to reduce negative affective response ('Reappraise' condition).

RESULTS

Results from an Analysis of Variance corrected for whole brain multiple comparisons showed a significant group x condition interaction in the left amygdala and left inferior frontal gyrus (IFG). Results from post-hoc analyses showed that the GAD group engaged these regions to a greater extent than HCs during Look-Negative but not Reappraise. Behaviorally, the GAD group reported feeling more negative than the HC group in each condition, although both groups reported reduced negative affect following regulation.

LIMITATIONS

As comorbidity was permitted, the presence of concurrent disorders, like other anxiety disorders and depression, detracts our ability to classify neural engagement particular to GAD alone.

CONCLUSIONS

Individuals with GAD exhibited over-engagement of amygdala and frontal regions during the viewing of negative images, compared to HCs. Together, these aberrations may indicate that deficits in emotional reactivity rather than regulation contribute to emotion dysregulation in those with GAD.

Lower Sensitivity to Happy and Angry Facial Emotions in Young Adults with Psychiatric Problems

Many psychiatric problem domains have been associated with emotion-specific biases or general deficiencies in facial emotion identification. However, both within and between psychiatric problem domains, large variability exists in the types of emotion identification problems that were reported. Moreover, since the domain-specificity of the findings was often not addressed, it remains unclear whether patterns found for specific problem domains can be better explained by co-occurrence of other psychiatric problems or by more generic characteristics of psychopathology, for example, problem severity. In this study, we aimed to investigate associations between emotion identification biases and five psychiatric problem domains, and to determine the domain-specificity of these biases. Data were collected as part of the ‘No Fun No Glory’ study and involved 2,577 young adults. The study participants completed a dynamic facial emotion identification task involving happy, sad, angry, and fearful faces, and filled in the Adult Self-Report Questionnaire, of which we used the scales depressive problems, anxiety problems, avoidance problems, Attention-Deficit Hyperactivity Disorder (ADHD) problems and antisocial problems. Our results suggest that participants with antisocial problems were significantly less sensitive to happy facial emotions, participants with ADHD problems were less sensitive to angry emotions, and participants with avoidance problems were less sensitive to both angry and happy emotions. These effects could not be fully explained by co-occurring psychiatric problems. Whereas this seems to indicate domain-specificity, inspection of the overall pattern of effect sizes regardless of statistical significance reveals generic patterns as well, in that for all psychiatric problem domains the effect sizes for happy and angry emotions were larger than the effect sizes for sad and fearful emotions. As happy and angry emotions are strongly associated with approach and avoidance mechanisms in social interaction, these mechanisms may hold the key to understanding the associations between facial emotion identification and a wide range of psychiatric problems.