Attentional biases to threat in social anxiety disorder: time to focus our attention elsewhere?

Social memory characteristics of non-clinical college students with social anxiety

According to the cognitive theory of social anxiety, the cognitive schema of people with social anxiety makes them easily attracted by threatening information and memory processing. Two experiments explored the social memory characteristics of college students with social anxiety. In Experiment 1, the study investigated the social memory bias of college students with social anxiety. In Experiment 2, cue word technology was used to investigate the social autobiographical memory amount and generalization degree of college students with social anxiety using cue words. The results showed that: (1) Compared with low social anxiety college students, college students with high social anxiety had a memory bias for negative social information, but did not have a negative memory bias for irrelevant social information; (2) Compared with low social anxiety college students, college students with high social anxiety had more negative social autobiographical memory; (3) Compared with low social anxiety college students, college students with high social anxiety have a higher degree of social autobiographical memory generalization. This study revealed that college students with high social anxiety had a negative memory bias toward social information, the amount of negative social autobiographical memory was larger and the degree of social autobiographical memory generalization was higher, providing new perspectives for future interventions in this population.

Social anxiety does not impair attention inhibition: An emotion anti-saccade task

BACKGROUND AND OBJECTIVES

Attention avoidance and attention vigilance are two typical attentional biases in individuals with social anxiety disorder (SAD). Attention inhibition is a type of attention control, which may be the key factor affecting attention vigilance and attention avoidance. However, previous studies have not examined the difference between the attention inhibition in individuals with SAD and healthy controls.

METHODS

To further explore this question, the current study used the single anti-saccade task with emotional facial stimuli to assess attention inhibition in 27 individuals with SAD and 22 healthy controls.

RESULTS

Regardless of the emotional valence of the facial stimuli, error rates in the social anxiety group were lower than that of the healthy control group, but there was no significant group difference in the saccade latency.

LIMITATIONS

This research only examined the attentional inhibition process highly related to attention avoidance and attention vigilance. Future research may benefit from adopting different research paradigms for more robust and generalizable conclusions.

CONCLUSIONS

Results suggest that individuals with SAD have better attention inhibition abilities than healthy control. Such enhanced attention inhibition may underlie their avoidance of threatening social cues.

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.

Self-focused attention related to social anxiety during free speaking tasks activates the right frontopolar area

Self-focused attention (SFA) and other-focused attention (OFA) are central maintenance factors of social anxiety. Tomita et al., Cognitive Therapy and Research 44:511–525, 2020 investigated brain activities when manipulating SFA and OFA during speech tasks, after controlling for social anxiety, using near-infrared spectroscopy (NIRS) and eye-tracking. Compared with the control condition, the SFA condition demonstrated greater activity in the right frontopolar area (rFPA) and right dorsolateral prefrontal cortex. In the OFA condition, relative to controls, activity was greater in the left superior temporal gyrus. We investigated whether the activity in these brain areas increased in healthy individuals in proportion to their social anxiety tendency without manipulating SFA and OFA. Thirty-nine participants performed speech tasks under a no attentional manipulation (no-instruction) condition and a control (looking at various places) condition. Brain activity was measured using NIRS (oxy-Hb responses), and eye movements were tracked. We found that higher social anxiety was associated with higher rFPA activity in the no-instruction condition compared to the control condition and that higher subjective SFA during the no-instruction condition with higher social anxiety was associated with increased rFPA between the no-instruction and control conditions. These results suggest that greater activity in the rFPA is a useful objective measure of SFA related to social anxiety during speech tasks.

Avoidance of social threat: Evidence from eye movements during a public speaking challenge using 360°- video

Social anxiety (SA) is thought to be maintained in part by avoidance of social threat, which exacerbates fear of negative evaluation. Yet, relatively little research has been conducted to evaluate the connection between social anxiety and attentional processes in realistic contexts. The current pilot study examined patterns of attention (eye movements) in a commonly feared social context - public speaking. Participants (N = 84) with a range of social anxiety symptoms gave an impromptu five-minute speech in an immersive 360°-video environment, while wearing a virtual reality headset equipped with eye-tracking hardware. We found evidence for the expected interaction between fear of public speaking and social threat (uninterested vs. interested audience members). Consistent with prediction, participants with greater fear of public speaking looked fewer times at uninterested members of the audience (high social threat) compared to interested members of the audience (low social threat) b = 0.418, p = 0.046, 95% CI [0.008, 0.829]. Analyses of attentional indices over the course of the speech revealed that the interaction between fear of public speaking and gaze on audience members was only significant in the first three-minutes. Our results provide support for theoretical models implicating avoidance of social threat as a maintaining factor in social anxiety. Future research is needed to test whether guided attentional training targeting in vivo attentional avoidance may improve clinical outcomes for those presenting with social anxiety.

Development of the Trans and Gender Diverse Social Anxiety Scale

Objectives: We develop and evaluate a Trans and Gender Diverse Social Anxiety Scale (TSAS) suitable for use with trans and gender diverse (TGD) people. Methods: We evaluate the TSAS on a sample of 171 TGD adults (40 transmen, 80 transwomen, and 51 gender nonbinary). We test the TSAS's construct validity against measures of perceived and enacted anti-trans stigma, and in comparison to a generic (i.e., non-TGD-specific) measure of social anxiety, the Liebowitz Social Anxiety Scale (LSAS). Results: Factor analyses reveal a four-factor structure consisting of fear and avoidance of (i) social interactions with familiar people, (ii) public scrutiny, (iii) interactions with organizations, and (iv) interactions with religious people or religious authority. Hierarchical regressions confirm that although symptoms of social anxiety assessed by the TSAS overlap with symptoms of generic social anxiety, responses to the TSAS target social situations specifically related to anti-trans stigma. MANOVAs of TSAS score by TGD gender subgroups also reveal that transmen report more social anxiety than either gender nonbinary TGD people or transwomen. Conclusions: The TSAS is a brief instrument that can be used to measure social anxiety in TGD people in social situations in which anti-trans stigma is commonly encountered.

Social anxiety and attentional bias variability: electrophysiological evidence of attentional control deficits

Attentional control has an important role in attentional bias in social anxiety. This study aimed to investigate whether attentional bias in social anxiety was caused by attentional control deficit. Event-related potentials and behavioural attentional bias index (trial-level attentional bias variability) were recorded as participants completed the dot-probe task. The behaviour result showed that compared with the low socially anxious individuals, the high socially anxious individuals had a marginally higher score of attentional bias variability. For event-related potentials results, target-locked frontocentral N2 amplitude was significantly larger under the incongruent condition than the congruent condition in the low socially anxious group, whereas there was no significant difference between these two conditions in the high socially anxious group. The low socially anxious group also exhibited reduced target-locked P2 amplitude from the congruent condition to the incongruent condition. Our findings provide electrophysiological evidence of attentional control dysregulation in socially anxious individuals, which contributes to modifying social anxiety-related attentional bias.

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.

Somatic complaints in children and adolescents with social anxiety disorder

BACKGROUND

Associations of social anxiety disorder (SAD) with various somatic symptoms have been already reported in the literature several times. The present study investigated somatic complaints in children and adolescents with SAD compared to controls and evaluated the relationship between social anxiety and somatic symptom severity.

METHODS

Thirty children and adolescents with SAD were compared with 36 healthy age-matched controls. Self-reported fears were assessed using the Phobiefragebogen für Kinder und Jugendliche (PHOKI); emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL/4-18); and the Gießener Beschwerdebogen für Kinder und Jugendliche (GBB-KJ) was used to assess 59 somatic symptoms.

RESULTS

Parents and youth with SAD reported higher somatic symptom severity compared to controls. Youth with SAD more frequently reported stomach pain, circulatory complaints, and fatigue than controls. Specific group differences between SAD and control youth were found for the following single somatic symptoms: faintness, quickly exhausted, sensation of heat, stomachache, nausea, dizziness, and sudden heart complaints. Parents of girls with SAD reported higher somatic symptom severity than parents of boys with SAD.

CONCLUSIONS

The results demonstrated a significant positive association between somatic symptoms and social anxiety in youth. The results of the present study can help to develop improved screening measurements, which increase the proportion of children and adolescents with SAD receiving proper treatment.

Anxious and alert? Hypervigilance in social anxiety disorder

The vast majority of research on attentional biases to threat focusses on selective attention, even though several cognitive-behavioral models furthermore assume hypervigilance to be important in this regard. Thus, the current study examined hypervigilance in trait and state social anxiety. We analyzed visual scanpath lengths and fixation counts of participants with Social Anxiety Disorder (SAD) (n = 61) and healthy controls (n = 60) in a combined visual search and eye tracking paradigm, including photographs of facial expressions. Half of all participants were randomly assigned to a state anxiety induction. Interaction effects revealed opposed attentional patterns of participants with SAD as compared to healthy controls considering overall visual scanpath lengths (F(1,117) = 5.32, p = 0.023, η²_partial = 0.043) and fixation counts (F(1,117) = 5.10, p = 0.026, η²_partial = 0.042). Accordingly, participants with SAD showed signs of hypervigilance in the anxiety induction condition. In contrast, there was no main effect of diagnostic group, indicating that individuals with SAD shift their attentional focus to broad scanning behavior only under conditions of threat. Our results add to the small number of existing studies on hypervigilance in SAD and suggest the topic to be promising for future research.