Emotion regulation in social anxiety: a systematic investigation and meta-analysis using self-report, subjective, and event-related potentials measures

Daily-life reactivity and emotion regulation in children with social anxiety disorder

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10-13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder.

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Learning to be inventive in the face of statistics: A positive reappraisal intervention for statistics anxiety

BACKGROUND AND OBJECTIVES

The burden of statistics anxiety on students calls for effective interventions. This study investigated whether a cognitive reappraisal training designed to stimulate the generation of positive re-interpretations may yield behavioral changes in anxiety measures and changes in cerebral activation patterns reflecting the activation of approach/avoidance motivational tendencies (frontal EEG alpha asymmetry response).

METHODS

Three groups of female psychology students (n = 45) with statistics anxiety were tested. Two groups received a guided, two-week reappraisal training with either statistics-anxiety or general anxiety situations; the control group received no intervention.

RESULTS

Both training groups significantly increased their amount of positive re-interpretations from pre-to post-test compared to the control group. Increased habitual use of reappraisal in statistics situations and significant EEG changes reflecting more approach-oriented coping with anxiety occurred in the statistics-anxiety training group only. No changes in statistics anxiety and statistics attitudes were observed, suggesting that the training effects, though corroborated through neurophysiological changes, did not sufficiently translate to improving students' deep-rooted anxiety.

LIMITATIONS

Effects, though robust and following the same pattern, were observed in a small sample.

CONCLUSIONS

Our findings delineate a promising expandable approach for helping students' cope with statistics anxiety in a healthier way.

Emotions in social anxiety disorder: A review

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

Generalization of reappraisal to novel negative stimuli as evidenced by the LPP

Cognitive reappraisal is a well-studied emotion regulation technique that involves changing the meaning of stimuli. To be useful in everyday life, reappraisal's effects would ideally generalize from previously reappraised stimuli to novel, but similar stimuli, saving individuals from needing to generate novel interpretations for similar stimuli. Here, 41 participants were asked to use reappraisal to down-regulate their response to negative pictures from one category (e.g., snakes), and to view negative pictures from another category (e.g., guns) as well as neutral pictures (e.g., plants). In a subsequent task, participants passively viewed novel pictures from all three categories (e.g., snakes, guns, and plants). EEG and subjective ratings of valence and arousal were collected in both tasks. In the reappraisal task, we did not find an effect of reappraisal on the LPP or arousal ratings, but reappraisal reduced ratings of picture unpleasantness. In the second task, negative pictures from the previously reappraised category elicited smaller LPPs than negative pictures from the previously viewed category, though there was no evidence that reappraisal generalized to subjective ratings of pictures. Therefore, at the electrocortical level, cognitive reappraisal may generalize to similar but novel stimuli encountered outside of the reappraisal context. Moreover, meaning change might be more effective in modulating electrocortical response following a delay and in the absence of deliberate attempts to down-regulate emotional response. Nonetheless, reappraisal's effects appear to differ across levels of affective response when similar stimuli are encountered in the absence of willful attempts at reappraisal.

The causal role of the bilateral ventrolateral prefrontal cortices on emotion regulation of social feedback

The ventrolateral prefrontal cortices (VLPFC) are crucial regions involved in voluntary emotion regulation. However, the lateralization of the VLPFC in downregulating negative emotions remains unclear; and whether the causal role of the VLPFC is generalizable to upregulating positive emotions is unexplored. This study used transcranial magnetic stimulation (TMS) to examine the causal relationship between the left/right VLPFC and social emotion reappraisal. One hundred and twenty participants were randomly assigned to either active (left and right VLPFC groups, n = 40/40) or sham (vertex, n = 40) TMS groups. Participants were instructed to passively receive social feedback or use reappraisal strategies to positively regulate their emotions. While the subjective emotional rating showed that the bilateral VLPFC facilitated the reappraisal success, the electrophysiological measure of the late positive potential (LPP) demonstrated a more critical role of the right VLPFC on social pain relief (decreased LPP amplitudes) and social reward magnification (enhanced LPP amplitudes). In addition, the influence of emotion regulation on social evaluation was found to be mediated by the memory of social feedback, indicating the importance of memory in social behavioral shaping. These findings suggest clinical protocols for the rehabilitation of emotion-regulatory function in patients with affective and social disorders.

The role of expressive suppression and cognitive reappraisal in cognitive behavioral therapy for social anxiety disorder: A study of self-report, subjective, and electrocortical measures

BACKGROUND

Contemporary models of cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) emphasize emotion dysregulation as a core impairment whose reduction may play a causal role in psychotherapy. The current study examined changes in use of emotion regulation strategies as possible mechanisms of change in CBT for SAD. Specifically, we examined changes in expressive suppression and cognitive reappraisal during CBT and whether these changes predict treatment outcome.

METHODS

Patients (n = 34; 13 females; Mean age = 28.36 (6.97)) were allocated to 16-20 sessions of CBT. An electrocortical measure of emotion regulation and a clinician-rated measure of SAD were administered monthly. Self-report measures of emotion regulation and social anxiety were administered weekly. Multilevel models were used to examine changes in emotion regulation during treatment and cross-lagged associations between emotion regulation and anxiety.

RESULTS

CBT led to decreased suppression frequency, increased reappraisal self-efficacy, and decreased unpleasantness for SAD-related pictures (ps < .05). At post-treatment, patients were equivalent to healthy controls in terms of suppression frequency and subjective reactivity to SAD-related stimuli. Gains were maintained at 3-months follow-up. Decreases in suppression frequency and electrocortical reactivity to SAD-related pictures predicted lower subsequent anxiety but not the other way around (ps < .05). Lower anxiety predicted greater subsequent increases in reappraisal self-efficacy.

LIMITATIONS

The lack of a control group precludes conclusions regarding mechanisms specificity.

CONCLUSIONS

Decreased frequency of suppression is a potential mechanism of change in CBT for SAD.

Individual differences in emotion regulation and face recognition

Face recognition ability is highly variable among neurologically intact populations. Across three experiments, this study examined for the first time associations between individual differences in a range of adaptive versus maladaptive emotion regulation strategies and face recognition. Using an immediate face-memory paradigm, in which observers had to identify a self-paced learned unfamiliar face from a 10-face target-present/ target-absent line-up, Experiment 1 (N = 42) found high levels of expressive suppression (the ongoing efforts to inhibit emotion-expressive behaviors), but not cognitive reappraisal (the cognitive re-evaluation of emotional events to change their emotional consequences), were associated with a lower level of overall face-memory accuracy and higher rates of misidentifications and false positives. Experiment 2 (N = 53) replicated these finding using a range of face-matching tasks, where observers were asked to match pairs of same-race or different-race face images taken on the same day or during different times. Once again, high levels of expressive suppression were associated with a lower level of overall face-matching performance and higher rates of false positives, but cognitive reappraisal did not correlate with any face-matching measure. Finally, Experiment 3 (N = 52) revealed that the higher use of maladaptive cognitive emotion regulation strategies, especially catastrophizing, was associated with lower levels of overall face-matching performances and higher rates of false positives. All told, the current research provides new evidence concerning the important associations between emotion and cognition.

The effects of positive interpretation bias on cognitive reappraisal and social performance: Implications for social anxiety disorder

People with social anxiety disorder (SAD) lack non-socially anxious individuals' tendency to interpret ambiguous social information in a positively biased manner. To gain a better understanding of the specific in-vivo social consequences of positive interpretation bias, we recruited 38 individuals with SAD and 31 healthy controls (HC) to participate in an in-vivo social task. We tested whether a positive interpretation bias, measured using a sentence completion task, might confer benefits for the adaptive emotion regulation strategy of cognitive reappraisal, and whether such benefits depended on participants' emotional states. We also examined whether positive interpretation bias might confer additional benefits such as improved self-perceived and observer-rated social performance. In support of prior research, HC participants exhibited a positive interpretation bias on the sentence completion task, whereas participants with SAD did not. Regression analyses revealed that positive interpretation bias predicted greater cognitive reappraisal during social stress, particularly when state positive affect was low. Moreover, positive interpretation bias predicted more positive self-perception of social performance and reduced underestimations of performance relative to observer ratings. These results suggest that positive interpretations of ambiguous social information may be related to increased use of cognitive reappraisal and more positive self-perceptions of social performance.

Parental Socialization, Social Anxiety, and School Victimization: A Mediation Model

The aim of this study was to examine the relationship between parenting dimensions (involvement/acceptance vs. strictness/imposition) and school victimization, considering the possible mediating role of social anxiety. The sample comprised 887 adolescents (52.3% girls) aged between 12 and 16 (M = 13.84 and SD = 1.22) enrolled at three compulsory secondary education ("ESO" or "Educación Secundaria Obligatoria" in Spanish) schools located in the provinces of Valencia, Teruel and Seville (Spain). A structural equations model was developed using the Mplus 7.4 program. The results obtained indicate that social anxiety mediates the relationship between parenting dimensions (involvement/acceptance vs. strictness/imposition) and school victimization. Finally, the results and their potential theoretical and practical implications are discussed.

Effects of working memory training on EEG, cognitive performance, and self-report indices potentially relevant for social anxiety

Social anxiety (SA) is quite common and associated with multiple comorbidities. Here, we examined the effects of working memory (WM) training on various indices potentially related to SA. Pre-selected university students with elevated self-reported SA symptoms were assigned to a WM training (n = 21) or an active control treatment condition (n = 21). Pre- and post-treatment assessments were made using questionnaires related to (social) anxiety and depression, and tasks measuring WM, interference control, and attentional biases towards, and event-related potentials (ERPs) elicited by, angry faces. The training enhanced WM transfer task performance, reduced SA symptoms, and changed the amplitude of the P1, N170, P2, and N2 ERP components. However, the latter changes did not mediate the effect of WM training on SA symptoms. These data provide preliminary evidence of the usefulness of WM trainings to reduce potential indices of SA, but further research is necessary to unravel the causal relation among these indices.

When negative interpretations persist, positive emotions don't! Inflexible negative interpretations encourage depression and social anxiety by dampening positive emotions

Research on emotion regulation difficulties has been instrumental in understanding hallmark features of depression and social anxiety. Yet, the cognitive mechanisms that give rise to maladaptive patterns of emotion regulation strategy use remain underspecified. This investigation examined the association of negative interpretation inflexibility and interpretation biases with the use of common emotion regulation strategies in response to negative and positive emotional experiences (repetitive negative thinking, positive reappraisal, and dampening). Study 1 (N = 250) found that inflexibility in revising negative interpretations in response to disconfirmatory positive information was related to the dampening of positive emotions, but not to repetitive negative thinking or positive reappraisal. Importantly, dampening mediated the relation between inflexible negative interpretations and symptoms of both depression and social anxiety. This mediation model was further supported by the data from Study 2 (N = 294). Across both studies, negative interpretation bias was related to repetitive negative thinking and dampening, whereas positive interpretation bias was related to positive reappraisal. Collectively, these results suggest that both interpretation inflexibility and interpretation biases may contribute to difficulties in emotion regulation related to depression and social anxiety.

Are individuals diagnosed with social anxiety disorder successful in regulating their emotions? A mixed-method investigation using self-report, subjective, and event-related potentials measures

BACKGROUND

Models of social anxiety emphasize the role of emotion dysregulation, but the nature of these impairments needs clarification.

METHODS

We utilized a mixed-method approach to examine impairments in cognitive reappraisal and expressive suppression in social anxiety disorder. Forty nine treatment-seeking individuals diagnosed with social anxiety disorder and 35 healthy controls completed self-reports and a lab-based task of suppression and reappraisal. Unpleasantness ratings and event-related potentials (ERPs) were collected while participants regulated their emotions in response to shame-arousing pictures. ERP analyses focused on the late positive potential, a measure of increased attention to emotional stimuli that is reduced during emotion regulation.

RESULTS

Participants with social anxiety reported less frequent and effective use of reappraisal and more frequent and effective use of suppression than controls. Counter to most models and our hypotheses, participants with social anxiety were more successful than controls in lab-based reappraisal as measured by unpleasantness ratings, but no differences emerged for ERPs. No differences were found in measures of lab-based suppression.

LIMITATIONS

Use of standardized, and not participant-generated, materials in the lab-based task of emotion regulation may limit the generalizability of the findings.

CONCLUSIONS

Subjective appraisals of self-efficacy and frequency suggest strong impairments in emotion-regulation in social anxiety that are not revealed in the laboratory. Models and treatment protocols should specify the exact nature of emotion dyregulation in social anxiety, highlighting difficulties in implementation of potentially intact emotion regulation abilities.