Preliminary findings: neural responses to feedback regarding betrayal and cooperation in adolescent anxiety disorders

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population

INTRODUCTION

Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms.

METHODS

Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-related symptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms.

RESULTS

Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity.

CONCLUSIONS

Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

The Prisoner's Dilemma paradigm provides a neurobiological framework for the social decision cascade

To function during social interactions, we must be able to consider and coordinate our actions with other people's perspectives. This process unfolds from decision-making, to anticipation of that decision's consequences, to feedback about those consequences, in what can be described as a "cascade" of three phases. The iterated Prisoner's Dilemma (iPD) task, an economic-exchange game used to illustrate how people achieve stable cooperation over repeated interactions, provides a framework for examining this "social decision cascade". In the present study, we examined neural activity associated with the three phases of the cascade, which can be isolated during iPD game rounds. While undergoing functional magnetic resonance imaging (fMRI), 31 adult participants made a) decisions about whether to cooperate with a co-player for a monetary reward, b) anticipated the co-player's decision, and then c) learned the co-player's decision. Across all three phases, participants recruited the temporoparietal junction (TPJ) and the dorsomedial prefrontal cortex (dmPFC), regions implicated in numerous facets of social reasoning such as perspective-taking and the judgement of intentions. Additionally, a common distributed neural network underlies both decision-making and feedback appraisal; however, differences were identified in the magnitude of recruitment between both phases. Furthermore, there was limited evidence that anticipation following the decision to defect evoked a neural signature that is distinct from the signature of anticipation following the decision to cooperate. This study is the first to delineate the neural substrates of the entire social decision cascade in the context of the iPD game.

Research Review: Pediatric anxiety disorders - what have we learnt in the last 10 years?

BACKGROUND

Anxiety disorders first emerge during the critical developmental periods of childhood and adolescence. This review synthesizes recent findings on the prevalence, risk factors, and course of the anxiety disorders; and their neurobiology and treatment.

METHODS

For this review, searches were conducted using PubMed, PsycINFO, and clinicaltrials.gov. Findings related to the epidemiology, neurobiology, risk factors, and treatment of pediatric anxiety disorders were then summarized.

FINDINGS

Anxiety disorders are high prevalence, and early-onset conditions associated with multiple risk factors including early inhibited temperament, environment stress, and structural and functional abnormalities in the prefrontal-amygdala circuitry as well as the default mode and salience networks. The anxiety disorders are effectively treated with cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

CONCLUSIONS

Anxiety disorders are high prevalence, early-onset conditions associated with a distinct neurobiological fingerprint, and are consistently responsive to treatment. Questions remain regarding who is at risk of developing anxiety disorders as well as the way in which neurobiology predicts treatment response.

Neural processing of iterated prisoner's dilemma outcomes indicates next-round choice and speed to reciprocate cooperation

The iterated prisoner's dilemma (iPD) game is a well-established model for testing how people cooperate, and the neural processes that unfold after its distinct outcomes have been partly described. Recent theoretical models suggest evolution favors intuitive cooperation, which raises questions on the behavioral but also neural timelines involved. We studied the outcome/feedback stage of iPD rounds with electroencephalography (EEG) methods. Results showed that neural signals associated with this stage also relate to future choice, in an outcome-dependent manner: (i) after zero-gain "sucker's payoffs" (unreciprocated cooperation), a participant's decision thereafter relates to changes to the feedback-related negativity (FRN); (ii) after one-sided non-cooperation (participant wins at co-player's expense), by the P3; (iii) after mutual cooperation, by late frontal delta-band modulations. Critically, faster reciprocation behavior towards a co-player's choice to cooperate was predicted, on a single-trial basis, by players' P3 and frontal delta modulations at the immediately preceding trial. Delta-band signaling is discussed in relation to homeostatic regulation processing in the literature. The findings relate the early outcome/feedback stage to subsequent decisional processes in the iPD, providing a first neural account of the brief timelines implied in heuristic modes of cooperation.

A review of neuroeconomic gameplay in psychiatric disorders

Abnormalities in social interaction are a common feature of several psychiatric disorders, aligning with the recent move towards using Research Domain Criteria (RDoC) to describe disorders in terms of observable behaviours rather than using specific diagnoses. Neuroeconomic games are an effective measure of social decision-making that can be adapted for use in neuroimaging, allowing investigation of the biological basis for behaviour. This review summarises findings of neuroeconomic gameplay studies in Axis 1 psychiatric disorders and advocates the use of these games as measures of the RDoC Affiliation and Attachment, Reward Responsiveness, Reward Learning and Reward Valuation constructs. Although research on neuroeconomic gameplay is in its infancy, consistencies have been observed across disorders, particularly in terms of impaired integration of social and cognitive information, avoidance of negative social interactions and reduced reward sensitivity, as well as a reduction in activity in brain regions associated with processing and responding to social information.

Social Feedback Modulates Neural Response Associated With Cognitive Bias in Individuals Expressing Anxious Symptoms

BACKGROUND

Social anxiety is characterized by a tendency to overestimate the likelihood of negative outcomes and consequences before, during, and after interpersonal interactions with social partners. Recent evidence suggests that a network of brain regions critical for perspective-taking, threat appraisal, and uncertainty resolution may function atypically in those prone to social anxiety. In this study, we used functional magnetic resonance imaging to examine neural activity in specific regions of interest in a sample of young adults who endorsed high or low levels of social anxiety.

METHODS

We recruited 31 college student volunteers (age: 18-28 years), categorized as having high or low anxiety based on their Liebowitz Social Anxiety Scale-Self Report scores. These participants were each scanned while playing the iterated Prisoner's Dilemma game with three computerized confederates, two of whom they were deceived to believe were human co-players. This study focuses on data collected during play with the presumed humans. Regions of interest were defined for the temporoparietal junction, anterior midcingulate, and dorsomedial prefrontal cortex. Average weighted mean blood-oxygen-level-dependent signals for each subject were extracted and analyzed using mixed design analyses of variance to detect group differences in activation during decision-making, anticipation, and appraisal of round outcomes during the game.

RESULTS

Behavior analysis revealed that the high-anxiety group was more likely to defect than the low-anxiety group. Neuroimaging analysis showed that the high-anxiety group exhibited elevated blood-oxygen-level-dependent activity relative to the low-anxiety group in all three regions during the social feedback appraisal phase but not during decision-making or the anticipation of interaction outcomes.

CONCLUSIONS

These findings provide evidence that some behaviors linked to cognitive biases associated with social anxiety may be mediated by a network of regions involved in recognizing and processing directed social information. Future investigation of the neural basis of cognition and bias in social anxiety using the prisoner's dilemma and other economic-exchange tasks is warranted. These tasks appear to be highly effective, functional magnetic resonance imaging-compatible methods of probing altered cognition and behavior associated with anxiety and related conditions.

Getting less than their fair share: Maltreated youth are hyper-cooperative yet vulnerable to exploitation in a public goods game

Human cooperative behavior has long been thought to decline under adversity. However, studies have primarily examined perceived patterns of cooperation, with little eye to actual cooperative behavior embedded within social interaction. Game-theoretical paradigms can help close this gap by unpacking subtle differences in how cooperation unfolds during initial encounters. This study is the first to use a child-appropriate, virtual, public goods game to study actual cooperative behavior in 329 participants aged 9-16 years with histories of maltreatment (n = 99) and no maltreatment (n = 230) while controlling for psychiatric symptoms. Unlike work on perceived patterns of cooperation, we found that maltreated participants actually contribute more resources to a public good during peer interaction than their nonmaltreated counterparts. This effect was robust when controlling for psychiatric symptoms and peer problems as well as demographic variables. We conclude that maltreatment may engender a hyper-cooperative strategy to minimize the odds of hostility and preserve positive interaction during initial encounters. This, however, comes at the cost of potential exploitation by others.

Social and academic functioning in adolescents with anxiety disorders: A systematic review

BACKGROUND

Anxiety disorders are highly prevalent during adolescence. Although literature points out that anxiety symptoms are related to problems in social and academic functioning, the extent of these problems among adolescents with clinical anxiety disorders has not been systematically reviewed before.

METHODS

Electronic databases were searched up to October 2017, with keywords representing anxiety disorders, adolescents, and social or academic functioning. The inclusion criteria were studies with a sample of adolescents (10-19 years) with anxiety disorders that provided data regarding their social or academic functioning. 3431 studies were examined, of which 19 met the inclusion criteria.

RESULTS

Adolescents with anxiety disorders had a lower social competence relative to their healthy peers. They reported more negativity within interpersonal relationships, higher levels of loneliness, and victimization. Most adolescents with anxiety disorders felt impaired at school, however, findings of their average school results, compared to peers, were mixed. In addition, they had a higher risk for school refusal and entered higher education less often. Impairments in social and academic functioning differed across type and the number of anxiety disorders.

LIMITATIONS

Most studies examined social phobia or anxiety disorders in general and methodological approaches varied widely between studies.

CONCLUSIONS

This systematic review indicates that adolescents with anxiety disorders experience a range of significant problems in both social and academic functioning. These findings suggest that the assessment and treatment of anxiety disorders in adolescence should focus on improving functioning across domains.

Clarifying the Behavioral Economics of Social Anxiety Disorder: Effects of Interpersonal Problems and Symptom Severity on Generosity

Social anxiety disorder is associated with lower interpersonal warmth, possibly explaining its associated interpersonal impairment. Across two samples, we attempted to replicate previous findings that the disorder's constraint of interpersonal warmth can be detected via behavioral economic tasks. We also tested the test-retest stability of task indices. Results indicated that factors associated with social anxiety disorder (and not the disorder itself), such as the severity of social anxiety and more extreme interpersonal problems, lead to less generous behavior on the economic task examined. Results were clearest regarding fine-grained indices derived from latent trajectories. Unexpectedly, the combination of generalized anxiety disorder and higher depression also restricted generosity. Two of three indices showed acceptable test-retest stability. Maladaptive giving behavior may be a treatment target to improve interpersonal functioning in psychiatric disorders; therefore, future work should more precisely characterize behavioral economic tasks, including basic psychometric work (i.e., tests of reliability and validity).

Neural correlates of social exchanges during the Prisoner's Dilemma game in depression

BACKGROUND

Depression is a disabling disorder that significantly impacts on the interpersonal functioning of individuals. However, little is known about the neural substrates of such difficulties. In the last few years neuroeconomics, which combines imaging with multiplayer behavioural economic paradigms, has been used to study the neural substrates of normal and abnormal interpersonal interactions.

METHOD

This study used functional magnetic resonance imaging to investigate neural activity in unmedicated depressed participants (n = 25) and matched healthy controls (n = 25). During scanning, participants played a behavioural economic game, the Prisoner's Dilemma. In this game, the participant and a co-player independently choose either to cooperate or not cooperate with each other.

RESULTS

Depressed participants reported higher levels of negative feelings (betrayal, guilt) during the game than did controls. Neural activation was compared between 'imbalanced' events [when one of the players cooperated and the other defected ('CD' and 'DC')] and 'draw' events [when both players either cooperated or defected ('CC' and 'DD')]. Participants preferentially activated the anterior insula and the dorsolateral prefrontal cortex (DLPFC), a region implicated in cognitive control and regulation of emotions. Importantly, compared to controls depressed participants showed reduced activation in the left DLPFC, with the extent of signal reduction correlating with increased self-report feelings of guilt associated with DC outcomes.

CONCLUSIONS

Our findings suggest that depression is associated with reduced activation of the DLPFC during social events that involve unreciprocated cooperation. This abnormality may underlie anomalies in cognitive control and top-down regulation of emotions during challenging social exchanges.

Behavioral and emotional responses to interpersonal stress: A comparison of adolescents engaged in non-suicidal self-injury to adolescent suicide attempters

Prominent theoretical models and existing data implicate interpersonal factors in the development and maintenance of suicidal behavior and non-suicidal self-injury (NSSI). However, no known study has yet used computerized behavioral tasks to objectively assess responses to interpersonal conflict/collaboration among teens engaged in NSSI or having made a suicide attempt. The current study, therefore, compared interpersonal functioning indexed by the Prisoner's Dilemma (PD) task among three mutually exclusive groups, adolescents (ages 13-17): engaged in NSSI only without history of a suicide attempt (n=26); who made a suicide attempt without history of NSSI (n=26); and typically developing controls (n=26). Participants also completed the Interpersonal Sensitivity Measure to assess their general sensitivity to/awareness of others' behaviors and feelings. No significant between-group differences were found in PD task performance; however, compared to typically developing control participants and those who had made a suicide attempt, the NSSI group reported significantly more stress during the task. Additionally, NSSI participants rated themselves as more interpersonally sensitive compared to both attempters and typically developing controls. Given the lack of knowledge about whether these groups either differentially activate the same circuitry during stressful interpersonal interactions or instead rely on alternative, compensatory circuits, future work using event-related functional magnetic resonance imaging is warranted.

Neural and cortisol responses during play with human and computer partners in children with autism

Children with autism spectrum disorder (ASD) exhibit impairment in reciprocal social interactions, including play, which can manifest as failure to show social preference or discrimination between social and nonsocial stimuli. To explore mechanisms underlying these deficits, we collected salivary cortisol from 42 children 8-12 years with ASD or typical development during a playground interaction with a confederate child. Participants underwent functional MRI during a prisoner's dilemma game requiring cooperation or defection with a human (confederate) or computer partner. Search region of interest analyses were based on previous research (e.g. insula, amygdala, temporal parietal junction-TPJ). There were significant group differences in neural activation based on partner and response pattern. When playing with a human partner, children with ASD showed limited engagement of a social salience brain circuit during defection. Reduced insula activation during defection in the ASD children relative to TD children, regardless of partner type, was also a prominent finding. Insula and TPJ BOLD during defection was also associated with stress responsivity and behavior in the ASD group under playground conditions. Children with ASD engage social salience networks less than TD children during conditions of social salience, supporting a fundamental disturbance of social engagement.

A novel V1a receptor antagonist blocks vasopressin-induced changes in the CNS response to emotional stimuli: an fMRI study

Background: We hypothesized that SRX246, a vasopressin V1a receptor antagonist, blocks the effect of intranasally administered vasopressin on brain processing of angry Ekman faces. An interaction of intranasal and oral drug was predicted in the amygdala.

Methods: Twenty-nine healthy male subjects received a baseline fMRI scan while they viewed angry faces and then were randomized to receive oral SRX246 (120 mg PO twice a day) or placebo. After an average of 7 days of treatment, they were given an acute dose of intranasal vasopressin (40 IU) or placebo and underwent a second scan. The primary outcome was BOLD activity in the amygdala in response to angry faces. Secondary analyses were focused on ROIs in a brain regions previously linked to vasopressin signaling.

Results: In subjects randomized to oral placebo-intranasal vasopressin, there was a significantly diminished amygdala BOLD response from the baseline to post-drug scan compared with oral placebo-intranasal placebo subjects. RM-ANOVA of the BOLD signal changes in the amygdala revealed a significant oral drug × intranasal drug × session interaction (F_{(1, 25)} = 4.353, p < 0.05). Follow-up tests showed that antagonism of AVPR1a with SRX246 blocked the effect of intranasal vasopressin on the neural response to angry faces. Secondary analyses revealed that SRX246 treatment was associated with significantly attenuated BOLD responses to angry faces in the right temporoparietal junction, precuneus, anterior cingulate, and putamen. Exploratory analyses revealed that the interactive and main effects of intranasal vasopressin and SRX246 were not seen for happy or neutral faces, but were detected for aversive faces (fear + anger) and at a trend level for fear faces.

Conclusion: We found confirmatory evidence that SRX246 has effects on the amygdala that counter the effects of intranasal vasopressin. These effects were strongest for angry faces, but may generalize to other emotions with an aversive quality.

Neuroanatomic abnormalities in adolescents with generalized anxiety disorder: a voxel-based morphometry study

BACKGROUND

Despite recent data implicating functional abnormalities in the neurocircuitry underlying emotional processing in pediatric anxiety disorders, little is known regarding neurostructural abnormalities within these systems.

METHODS

Using voxel-based morphometry, gray and white matter volumes were compared in 15 medication-free adolescents with generalized anxiety disorder (GAD; and no comorbid major depressive disorder) and 28 age- and sex-matched healthy comparison subjects.

RESULTS

Compared to healthy adolescents, youth with GAD had larger gray matter volumes in the right precuneus and right precentral gyrus and decreased gray matter volumes in the left orbital gyrus and posterior cingulate. White matter volumes were decreased in the left medial and superior frontal gyrus and were increased in the left inferior temporal gyrus in youth with GAD relative to healthy subjects.

CONCLUSIONS

Adolescents with GAD, who are early in the course of their illness, exhibit abnormalities in neural structures that subserve threat appraisal, modulation of fear responses, attachment, and mentalization.

Interpersonal constraint conferred by generalized social anxiety disorder is evident on a behavioral economics task

Although social anxiety disorder appears to confer impairment in friendships, evidence beyond self-report is minimal. We used the flexible iterated prisoner's dilemma as a simulated interaction with a friend with 27 individuals with the generalized type of social anxiety disorder and 23 demographically equivalent individuals without the disorder. Participants with generalized social anxiety disorder were less giving on the task. Lower giving was also moderately associated with interpersonal variables (e.g., coldness). A trend was also found for participants with generalized social anxiety disorder to show lower assertiveness on the task. The connection between generalized social anxiety disorder and friendship impairment appears likely to be partially explained by interpersonal constraint that is perceived by others as coldness and manifests in a behavioral economics task.

Why do anxious children become depressed teenagers? The role of social evaluative threat and reward processing

BACKGROUND

Depression is a leading cause of worldwide disability. Adolescence represents a key developmental window in which rates of this disorder increase markedly. Children with an anxiety disorder show a particular risk of developing depression during adolescence.

METHOD

We present and review evidence for a developmental model that considers the intersection of two vulnerabilities relevant to the trajectory from anxiety to depression: difficulties in response to potential social evaluation and changes in reward processing at puberty.

RESULTS

Evidence suggests that these vulnerabilities (a) have been associated with depression, (b) are likely to be problematic in many, but not all, anxious youth, and (c) may be exacerbated by maturational processes that occur around pubertal development in ways that can create a negative spiral into a depressive disorder.

CONCLUSIONS

We discuss the possibility that early intervention strategies targeting key aspects of these vulnerabilities could alter the trajectory away from depression for many anxious youth.