Neural correlates of self-focused attention in social anxiety

Event-related potentials of social comparisons in depression and social anxiety

Social comparison is central in human life and can be especially challenging in depression and social anxiety. We assessed event-related potentials and emotions using a social comparison task in which participants received feedback on both their own and a co-player's performance, in participants with depression and/or social anxiety (n = 63) and healthy controls (n = 72). Participants reported more negative emotions for downward (being better than the co-player [participant correct, co-player wrong]) and upward (being worse than the co-player [participant wrong, co-player correct]) comparisons versus even outcomes, with these effects being stronger in depression and social anxiety. At the Medial Frontal Negativity, both controls and depressed participants showed a more negative amplitude for upward comparison versus both the participant and co-player performing wrong. Socially anxious subjects showed the opposite effect, possibly due to greater expectations about being worse than others. The P300 decreased for downward and upward comparisons compared to even outcomes, which may relate to the higher levels of conflict of social inequality. Depressed and socially anxious subjects showed a blunted P300 increase over time in response to the task outcomes, suggesting deficits in allocating resources for the attention of incoming social information. The LPP showed increased amplitude for downward and upward comparison versus the even outcomes and no group effect. Emotional findings suggest that social comparisons are more difficult for depressed and socially anxious individuals. Event-related potentials findings may shed light on the neural substrates of these difficulties.

Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

OBJECTIVES

Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety.

METHODS

Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity.

RESULTS

Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety.

CONCLUSIONS

The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.

Self-focused brain predictors of cognitive behavioral therapy response in a transdiagnostic sample

BACKGROUND

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre-to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.

METHODS

Twenty-seven patients with primary social anxiety disorder (n = 14) and primary body dysmorphic disorder (n = 13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex of the default mode network.

RESULTS

At pre-treatment, stronger positive connectivity of the seed with the cerebellum, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre-to post-treatment, greater anticorrelation between the seed and postcentral gyrus, extending into the inferior parietal lobule and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.

CONCLUSIONS

Pre-treatment functional connectivity with the default mode network was associated with CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.

Metaphorical language and psychopathological symptoms: a case study of trauma victims' metaphor use

BACKGROUND

While clinical diagnosis of mental health issues focuses on factual details represented by literal language (e.g., the onset and process of the triggering event and duration of symptom), the relationship between metaphorical language and psychopathological experiences remains an intriguing question. Focusing on psychological trauma triggered by the 2019-2020 Hong Kong social unrest, this study explored the correlations between trauma victims' quantitative metaphor usage patterns and their experience of specific Acute Stress Disorder (ASD) symptoms.

METHODS

Forty-six individuals with trauma exposure within 28 days were recruited through convenience sampling. Each completed a 20- to 30-minute semi-structured interview and filled out the Chinese version of the Stanford Acute Stress Reaction Questionnaire (SASRQ; 1). Metaphors in the interviews were identified using the discourse dynamic approach (2), and clinically interesting categories related to trauma and emotion expression, as revealed by previous literature, were sorted out. Standardized frequencies of the categories were correlated with participants' SASRQ scores of five major ASD symptoms, and the correlational patterns were interpreted from a discourse analytic perspective.

RESULTS

The study reveals how metaphor usage patterns can reflect the speakers' differentiated experiences of psychopathological symptoms. Compared with individuals who experienced less trauma, those more disturbed by the re-experiencing symptom were more inclined to use emotion-related metaphors and to metaphorize about the self and the self-society relationship. Individuals who experienced more severe anxiety and hyperarousal showed a heightened awareness of self-related issues and diminished attention to others. Those who suffered from more severe impairment in functioning produced more metaphors in the negative valence. Dissociation and avoidance, which were less experientially salient and intense than the others, were not significantly correlated with metaphor usage patterns.

CONCLUSION

This study establishes symptom-level metaphor usage patterns as a previously overlooked but interesting avenue in trauma evaluation, treatment, and research. While the study is confined to a single context, it nevertheless reveals the potential for metaphor research findings to be incorporated as useful materials in psychology education and therapist training.

Biological principles for music and mental health

Efforts to integrate music into healthcare systems and wellness practices are accelerating but the biological foundations supporting these initiatives remain underappreciated. As a result, music-based interventions are often sidelined in medicine. Here, I bring together advances in music research from neuroscience, psychology, and psychiatry to bridge music's specific foundations in human biology with its specific therapeutic applications. The framework I propose organizes the neurophysiological effects of music around four core elements of human musicality: tonality, rhythm, reward, and sociality. For each, I review key concepts, biological bases, and evidence of clinical benefits. Within this framework, I outline a strategy to increase music's impact on health based on standardizing treatments and their alignment with individual differences in responsivity to these musical elements. I propose that an integrated biological understanding of human musicality-describing each element's functional origins, development, phylogeny, and neural bases-is critical to advancing rational applications of music in mental health and wellness.

Work conflict: Another trigger to smartphone addiction of individuals with high rumination?

With the widespread use of smartphones, many people spend much time on smartphones for shopping, learning, socializing, and so on, which can affect an individual's mental health and work performance. Especially, individual perceived conflict at work may increase their social anxiety and thus raise the risk of their smartphone addiction. This study collected data from 577 corporate employees in China through convenience sampling to explain the influence mechanism of work conflict on smartphone addiction and to verify the moderating role of rumination. Statistical results show that relationship conflicts, task conflicts, and process conflicts positively affect smartphone addiction by enhancing social anxiety. Moreover, rumination positively moderates the relationship between work conflict and smartphone addiction. People with high rumination are more likely to escape reality due to conflict at work, which further enhances their smartphone addiction behaviors. Our study suggests that a relatively harmonious working atmosphere should be established within organizations, especially for employees with rumination. Work conflict is a predisposing factor for social anxiety and smartphone addiction in individuals with high rumination.

A brain model of altered self-appraisal in social anxiety disorder

The brain's default mode network has a central role in the processing of information concerning oneself. Dysfunction in this self-referential processing represents a key component of multiple mental health conditions, particularly social anxiety disorder (SAD). This case-control study aimed to clarify alterations to network dynamics present during self-appraisal in SAD participants. A total of 38 adolescents and young adults with SAD and 72 healthy control participants underwent a self-referential processing fMRI task. The task involved two primary conditions of interest: direct self-appraisal (thinking about oneself) and reflected self-appraisal (thinking about how others might think about oneself). Dynamic causal modeling and parametric empirical Bayes were then used to explore differences in the effective connectivity of the default mode network between groups. We observed connectivity differences between SAD and healthy control participants in the reflected self-appraisal but not the direct self-appraisal condition. Specifically, SAD participants exhibited greater excitatory connectivity from the posterior cingulate cortex (PCC) to medial prefrontal cortex (MPFC) and greater inhibitory connectivity from the inferior parietal lobule (IPL) to MPFC. In contrast, SAD participants exhibited reduced intrinsic connectivity in the absence of task modulation. This was illustrated by reduced excitatory connectivity from the PCC to MPFC and reduced inhibitory connectivity from the IPL to MPFC. As such, participants with SAD showed changes to afferent connections to the MPFC which occurred during both reflected self-appraisal as well as intrinsically. The presence of connectivity differences in reflected and not direct self-appraisal is consistent with the characteristic fear of negative social evaluation that is experienced by people with SAD.

Pre-COVID brain network topology prospectively predicts social anxiety alterations during the COVID-19 pandemic

Background

Social anxiety (SA) is a negative emotional response that can lead to mental health issues, which some have experienced during the coronavirus disease 2019 (COVID-19) pandemic. Little attention has been given to the neurobiological mechanisms underlying inter-individual differences in SA alterations related to COVID-19. This study aims to identify neurofunctional markers of COVID-specific SA development.

Methods

110 healthy participants underwent resting-state magnetic resonance imaging and behavioral tests before the pandemic (T1, October 2019 to January 2020) and completed follow-up behavioral measurements during the pandemic (T2, February to May 2020). We constructed individual functional networks and used graph theoretical analysis to estimate their global and nodal topological properties, then used Pearson correlation and partial least squares correlations examine their associations with COVID-specific SA alterations.

Results

In terms of global network parameters, SA alterations (T2-T1) were negatively related to pre-pandemic brain small-worldness and normalized clustering coefficient. In terms of nodal network parameters, SA alterations were positively linked to a pronounced degree centrality pattern, encompassing both the high-level cognitive networks (dorsal attention network, cingulo-opercular task control network, default mode network, memory retrieval network, fronto-parietal task control network, and subcortical network) and low-level perceptual networks (sensory/somatomotor network, auditory network, and visual network). These findings were robust after controlling for pre-pandemic general anxiety, other stressful life events, and family socioeconomic status, as well as by treating SA alterations as categorical variables.

Conclusions

The individual functional network associated with SA alterations showed a disrupted topological organization with a more random state, which may shed light on the neurobiological basis of COVID-related SA changes at the network level.

Self-Focused Brain Predictors of Cognitive Behavioral Therapy Response in a Transdiagnostic Sample

Background

Effective biomarkers of cognitive behavioral therapy (CBT) response provide information beyond available behavioral or self-report measures and may optimize treatment selection for patients based on likelihood of benefit. No single biomarker reliably predicts CBT response. In this study, we evaluated patterns of brain connectivity associated with self-focused attention (SFA) as biomarkers of CBT response for anxiety and obsessive-compulsive disorders. We hypothesized that pre-treatment as well as pre- to post-treatment changes in functional connectivity would be associated with improvement during CBT in a transdiagnostic sample.

Methods

Twenty-seven patients with primary social anxiety disorder (n=14) and primary body dysmorphic disorder (n=13) were scanned before and after 12 sessions of CBT targeting their primary disorder. Eligibility was based on elevated trait SFA scores on the Public Self-Consciousness Scale. Seed-based resting state functional connectivity associated with symptom improvement was computed using a seed in the posterior cingulate cortex/precuneus that delineated a self-other functional network.

Results

At pre-treatment, stronger positive connectivity of the seed with the cerebellum, insula, middle occipital gyrus, postcentral gyrus, and precuneus/superior parietal lobule, and stronger negative connectivity with the putamen, were associated with greater clinical improvement. Between pre- to post-treatment, greater anticorrelation between the seed and precuneus/superior parietal lobule was associated with clinical improvement, although this did not survive thresholding.

Conclusions

Pre-treatment functional connectivity between regions involved in attentional salience, self-generated thoughts, and external attention predicted greater CBT response. Behavioral and self-report measures of SFA did not contribute to predictions, thus highlighting the value of neuroimaging-based measures of SFA.

Clinical Trials Registration

ClinicalTrials.gov Identifier: NCT02808702 https://clinicaltrials.gov/ct2/show/NCT02808702.

The effect of trait anxiety on the time course of self-relevant processing: Evidence from the perceptual matching task

Studies have widely reported that trait anxiety is associated with a range of cognitive biases toward external negative emotional stimuli. However, few studies have examined whether trait anxiety modulates intrinsic self-relevant processing. This study investigated the electrophysiological mechanism underlying trait anxiety's modulating effect on self-relevant processing. Event-related potentials (ERPs) were recorded while participants performed a perceptual matching task that assigned an arbitrary geometric shape to an association with a "self" or "non-self" label. Results showed larger N1 amplitudes under self-association than under friend-association conditions, and smaller P2 amplitudes for self- than for stranger-association conditions in individuals with high trait anxiety. However, these self-biases in the N1 and P2 stages were not observed in those with low trait anxiety until the later N2 stage, in which the self-association condition provoked smaller N2 amplitudes than the stranger-association condition. In addition, both high and low trait anxiety individuals showed larger P3 amplitudes for the self-association condition than for the friend- and stranger-association conditions. These findings suggest that, although both high and low trait anxiety individuals showed self-bias, high trait anxiety individuals distinguished between self-relevant and non-self-relevant stimuli at an earlier stage, which may reflect hypervigilance to self-relevant stimuli.

Neural mechanisms of aberrant self-referential processing in patients with generalized anxiety disorder

Massive theoretical studies in clinical psychology have implicated the self in understanding internalizing disorders (i.e., anxiety and mood disorders), in which self-related tasks were frequently used to investigate internalizing psychopathology. As one of the most frequently seen internalizing disorder in primary care, patients with generalized anxiety disorder (GAD) are characterized by inappropriate self-related processing such as negative self-referential thinking. However, relevant neural mechanisms remain unknown. In this study, participants underwent a self-related task which they were presented with several positive and negative trait words and were required to judge the extent to which these traits matched themselves when compared to their average peers. Aberrant brain activation and functional connectivity of GAD were detected during processing positive and negative traits. Compared to healthy controls (HCs), patients with GAD exhibited abnormal self-processing which manifested as lower biased self-rating scores particularly for negative traits and weaker brain activity in the left dorsomedial prefrontal cortex, inferior frontal gyrus, superior temporal sulcus (STS), and bilateral lingual gyrus when processing trait words. Abnormal functional connections between these hypoactive regions and regions associated with reward, emotion, and theory of mind were observed in subsequent psychophysiological interaction analysis. An attenuation of connectivity between the left insula and left STS was associated with greater severity of anxiety symptom in GAD patients. These findings provide insight into the abnormal neurocognitive mechanisms of biased self-related processing in GAD patients, which involves distorted self-schema accompanied by abnormal activation and functional connections of regions implicated in self-related and social cognition processing.

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.

Maladaptive self-focused attention and default mode network connectivity: a transdiagnostic investigation across social anxiety and body dysmorphic disorders

Maladaptive self-focused attention (SFA) is a bias toward internal thoughts, feelings and physical states. Despite its role as a core maintaining factor of symptoms in cognitive theories of social anxiety and body dysmorphic disorders (BDDs), studies have not examined its neural basis. In this study, we hypothesized that maladaptive SFA would be associated with hyperconnectivity in the default mode network (DMN) in self-focused patients with these disorders. Thirty patients with primary social anxiety disorder or primary BDD and 28 healthy individuals were eligible and scanned. Eligibility was determined by scoring greater than 1SD or below 1SD of the Public Self-Consciousness Scale normative mean, respectively, for each group. Seed-to-voxel functional connectivity was computed using a DMN posterior cingulate cortex (PCC) seed. There was no evidence of increased DMN functional connectivity in patients compared to controls. Patients (regardless of diagnosis) showed reduced functional connectivity of the PCC with several brain regions, including the bilateral superior parietal lobule (SPL), compared to controls, which was inversely correlated with maladaptive SFA but not associated with social anxiety, body dysmorphic, depression severity or rumination. Abnormal PCC-SPL connectivity may represent a transdiagnostic neural marker of SFA that reflects difficulty shifting between internal versus external attention.

Alterations of regional spontaneous brain activities in anxiety disorders: A meta-analysis

BACKGROUND

Recent resting-state functional magnetic resonance imaging studies have provided strong evidence of abnormal regional spontaneous brain activities among anxiety-disordered patients. However, the evidence has been divergent and inconclusive. Therefore, it is necessary to perform a meta-analysis identifying a common pattern of altered regional spontaneous brain activity for anxiety disorders.

METHOD

Corresponding research of anxiety disorders, namely, whole-brain rs-fMRI studies that measured differences in regional homogeneity, amplitude of low-frequency fluctuations, or fractional amplitude of low-frequency fluctuations, were analyzed in this study. Overall, seven studies with 235 anxiety-disordered patients and 241 healthy controls were ultimately included in the meta-analysis. The meta-analysis was processed by seed-based d mapping.

RESULTS

Compared with healthy controls, patients with anxiety disorders showed significantly decreased regional spontaneous brain activities in the right putamen, the right orbital inferior frontal gyrus, and the right temporal pole. No increases in regional spontaneous brain activities were detected in patients relative to the controls.

LIMITATION

Limited number of available studies, only Asian samples, and insufficient information of sample characteristics.

CONCLUSION

The present study suggests that anxiety disorders are associated with aberrant regional brain activity in areas connected with emotion processing, which extends our understanding of anxiety disorders' pathophysiology.

Look at the Audience? A Randomized Controlled Study of Shifting Attention From Self-Focus to Nonsocial vs. Social External Stimuli During Virtual Reality Exposure to Public Speaking in Social Anxiety

Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli. Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects. Results: Within the analysis sample (n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group. Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.

Relationship Between Parental Marital Conflict and Social Anxiety Symptoms of Chinese College Students: Mediation Effect of Attachment

Social anxiety has been a common problem among college students and has an adverse impact on their adaptation outcomes. Among influential factors, parental marital conflict and attachment (parental and peer attachment) have been found to be related to social anxiety symptoms of college students; however, little is known how parental marital conflict and attachment jointly contribute to social anxiety symptoms of college students. The current study explored this issue. Self-reported questionnaires of perception of children of interparental conflict scale, inventory of parent and peer attachment, and the social interaction anxiety scale were administered to 707 undergraduate students (Mean age = 19.27, SD = 0.97). Results indicated that perceived parental marital conflict was positively correlated with social anxiety symptoms and was negatively associated with parental and peer attachment. Parental and peer attachments were negatively correlated with social anxiety symptoms. Mediation analyses indicated that perceived parental marital conflict exerted its indirect effect on social anxiety symptoms through a serial multiple mediation role of parental and peer attachment. The present findings highlight the serial multiple mediation role of parental and peer attachment in the relationship between perceived parental marital conflict and social anxiety symptoms of college students.

Five paths to personality coherence: Integrative implications of the Knowledge-and-Appraisal Personality Architecture

The study of personality coherence can be grounded in an analysis of personality architecture, that is, the overall structure and dynamics of intra-individual personality systems. A personality architecture can identify, and organize the study of, interrelated phenomena that each are instances of personality coherence. It thereby can provide an integrative framework for understanding relations among distinct lines of research. This thesis is advanced by drawing on the Knowledge-and-Appraisal Personality Architecture, or KAPA model. KAPA model principles distinguish among three classes of social-cognitive knowledge structures: beliefs, goals, and evaluative standards. These distinctions, in turn, provide a foundation for understanding five aspects of personality coherence: 1) Belief-Based Coherence, 2) Goal-Based Coherence, 3) Evaluative Standards-Based Coherence, 4) Intra-Psychic Coherence (that is, coherent functional interrelations among personality systems), and 5) Phenomenological Coherence. Research documenting each of these five paths to personality coherence is reviewed. The paper also reviews the strengths and limitations of 20th-century social-cognitive formulations that provide key foundations for the KAPA model.

Virtual Reality-Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

BACKGROUND

Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder.

OBJECTIVE

We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment.

METHODS

We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality-based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them.

RESULTS

Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality-based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy.

CONCLUSIONS

These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

Interoceptive active inference and self-representation in social anxiety disorder (SAD): exploring the neurocognitive traits of the SAD self

This article provides an interoceptive active inference (IAI) account of social anxiety disorder (SAD). Through a neurocognitive framework, we argue that the cognitive and behavioural profile of SAD is best conceived of as a form of maladaptive IAI produced by a negatively biased self-model that cannot reconcile inconsistent tendencies to approach and avoid social interaction. Anticipated future social interactions produce interoceptive prediction error (bodily states of arousal). These interoceptive states are transcribed and experienced as states of distress due to the influence of inconsistent and unstable self-models across a hierarchy of interrelated systems involved in emotional, interoceptive and affective processing. We highlight the role of the insula cortex, in concert with the striatum, amygdala and dorsal anterior cingulate in the generation and reduction of interoceptive prediction errors as well as the resolution of social approach-avoidance conflict. The novelty of our account is a shift in explanatory priority from the representation of the social world in SAD to the representation of the SAD self. In particular, we show how a high-level conceptual self-model of social vulnerability and inadequacy fails to minimize prediction errors produced by a basic drive for social affiliation combined with strong avoidant tendencies. The result is a cascade of interoceptive prediction errors whose attempted minimization through action (i.e. active inference) yields the symptom profile of SAD. We conclude this article by proposing testable hypotheses to further investigate the neurocognitive traits of the SAD self with respect to IAI.

A Distinct Neurophenotype of Fearful Face Processing in Alcohol Use Disorder With and Without Comorbid Anxiety

BACKGROUND

Individuals with alcohol use disorder (AUD) can present with comorbid anxiety symptoms and often have deficits in emotional processing. Previous research suggests brain response is altered during facial affect recognition tasks, especially in limbic areas, due to either AUD or anxiety symptomology; however, the impact of both AUD and clinically significant anxiety symptoms during these tasks has not yet been examined.

METHODS

In this study, we investigated neural activation differences during an emotional face-matching task. Participants (N = 232) underwent fMRI scanning, as part of a larger study. Three groups were investigated: individuals with diagnosed AUD and elevated anxiety traits (AUD + ANX, n = 90), individuals with diagnosed AUD but non-clinically significant levels of anxiety (AUD-ANX, n = 39), and healthy controls (HC, n = 103).

RESULTS

Our results illustrate distinct neurophenotypes of AUD, where individuals with comorbid anxiety symptomology have blunted emotional face processing while those with singular AUD are hyperresponsive.

CONCLUSIONS

This suggests AUD with anxiety symptomology may have a unique neurobiological underpinning, and treatment and intervention should be tailored to individual constellations of symptoms.

The heterogeneity of social anxiety symptoms among Chinese adolescents: Results of latent profile analysis

BACKGROUND

The main objective of the current study was to investigate the symptoms of social anxiety in Chinese adolescents by conducting latent profile analysis (LPA), a person-centered statistical approach, with items from the Social Anxiety Scale for Adolescents (SAS-A).

METHOD

In total, a sample of 2,755 adolescents aged 11‒19 years were recruited from six urban public schools in the Beijing District and Sichuan Province, China. Latent profile analysis, regression mixture modelling, and multinomial logistical regression were adopted to investigate the latent profiles and profiles validity.

RESULTS

A four-profile model was suggested as the optimum: low group with diffuse social anxiety, moderate group with difficulties in new situations, moderate group with cognitive disturbance, and high group with diffuse social anxiety. With regression mixture modelling, results showed a greater possibility for older adolescents and girls fall into the high group with diffuse social anxiety. Finally, to examine the validity and interpretability of the social anxiety profiles, two cognitive factors-post-event rumination and self-focused attention-were adopted for their potential to significantly predict the moderate and high group social anxiety profiles.

CONCLUSIONS

The current study, which was the first effort to investigate the features of social anxiety among Chinese adolescents with LPA, supports an innovative model of social anxiety symptoms in a large, non-Western sample. Limitations and clinical implications are included.

Not intended, still embarrassed: Social anxiety is related to increased levels of embarrassment in response to unintentional social norm violations

Background:

Social anxiety disorder (SAD) is associated with altered social norm (SN) processing: SAD-patients rate stories on SN violations as more inappropriate and more embarrassing than healthy participants, with the most prominent effect for stories on unintentional SN violations (i.e. committing a blunder). Until now it’s unknown how levels of social anxiety (SA) are related to ratings of SN violations in the general population, in which SA-symptoms are present at a continuum. More insight in this relationship could improve our understanding of the symptom profile of SAD. Therefore, we investigated the relation between ratings of SN violations and SA-levels in the general population.

Methods:

Adults and adolescents (n = 87) performed the revised Social Norm Processing Task (SNPT-R) and completed self-report questionnaires on social anxiety. Repeated-measures ANCOVAs were used to investigate the effect of SA on the ratings of inappropriateness and embarrassment.

Results:

As hypothesized, participants with higher SA-levels rated SN violations as more inappropriate and more embarrassing. Whereas participants with low-to-intermediate SA-levels rated unintentional SN violations as less embarrassing than intentional SN violations, participants with high SA-levels (z-score SA ≥ 1.6) rated unintentional SN violations as equally embarrassing as intentional SN violations.

Conclusion:

These findings indicate that increased embarrassment for unintentional SN violations is an important characteristic of social anxiety. These high levels of embarrassment are likely related to the debilitating concern of socially-anxious people that their skills and behavior do not meet expectations of others, and to their fear of blundering. This concern might be an important target for future therapeutic interventions.

Authenticity and rumination mediate the relationship between loneliness and well-being

In recent years, plentiful data has emerged indicating the detrimental effects of loneliness on well-being. One of the challenges for researchers dealing with this issue is to find the mechanism underlying the relationship. The present study investigated 293 adults, aged 19-40, and examined whether authenticity and rumination functioned as mediators in the relationship between loneliness and well-being (and its three domains – pleasure, engagement, and meaning). The results of the study confirmed the loneliness-well-being link and, additionally, revealed potential mechanisms explaining this relationship, which were of different character in the cases of the particular domains of well-being. As it turned out, authenticity was the sole significant mediator in the relationship between loneliness and meaning, and rumination played the role of key mediator between loneliness and pleasure. Both these mediators had their share in the indirect effects of loneliness on engagement and overall well-being. The relations revealed between loneliness and authenticity are, in turn, congruent with recent conceptualizations of authenticity, which emphasize the interpersonal sources of this variable.

Effect of Parent–Child Attachment on College Students’ Social Anxiety: A Moderated Mediation Model

This study investigated the relationship between parent–child attachment and social anxiety in college students, as well as the mediating role of psychological resilience and the moderating role of online social support. In total, 614 college students were recruited by the cluster sampling method. The results showed that (1) parent–child attachment was negatively correlated with college students’ social anxiety and positively correlated with their psychological resilience, (2) psychological resilience played a mediating role between parent–child attachment and college students’ social anxiety, and (3) online social support regulated the first half and second half of the mediation process in which parent–child attachment affected college students’ social anxiety through psychological resilience. These findings revealed the mechanism of parent–child attachment affecting social anxiety, which had important theoretical and empirical value for enhancing the strength of college students’ psychological resilience and alleviating social anxiety.

Brain activity sustaining the modulation of pain by empathetic comments

Empathetic verbal feedback from others has been shown to alleviate the intensity of experimental pain. To investigate the brain changes associated with this effect, we conducted 3T-fMRI measurements in 30 healthy subjects who received painful thermal stimuli on their left hand while overhearing empathetic, neutral or unempathetic comments, supposedly made by experimenters, via headsets. Only the empathetic comments significantly reduced pain intensity ratings. A whole-brain BOLD analysis revealed that both Empathetic and Unempathetic conditions significantly increased the activation of the right anterior insular and posterior parietal cortices to pain stimuli, while activations in the posterior cingulate cortex and precuneus (PCC/Prec) were significantly stronger during Empathetic compared to Unempathetic condition. BOLD activity increased in the DLPFC in the Empathetic condition and decreased in the PCC/Prec and vmPFC in the Unempathetic condition. In the Empathetic condition only, functional connectivity increased significantly between the vmPFC and the insular cortex. These results suggest that modulation of pain perception by empathetic feedback involves a set of high-order brain regions associated with autobiographical memories and self-awareness, and relies on interactions between such supra-modal structures and key nodes of the pain system.

Neural Correlates of Self-referential Processing and Their Clinical Implications in Social Anxiety Disorder

Social anxiety disorder (SAD) is associated with aberrant self-referential processing (SRP) such as increased self-focused attention. Aberrant SRP is one of the core features of SAD and is also related to therapeutic interventions. Understanding of the underlying neural correlates of SRP in SAD is important for identifying specific brain regions as treatment targets. We reviewed functional magnetic resonance imaging (fMRI) studies to clarify the neural correlates of SRP and their clinical implications for SAD. Task-based and resting fMRI studies have reported the cortical midline structures including the default mode network, theory of mind-related regions of the temporo-parietal junction and temporal pole, and the insula as significant neural correlates of aberrant SRP in SAD patients. Also, these neural correlates are related to clinical improvement on pharmacological and cognitive-behavioral treatments. Furthermore, these could be candidates for the development of novel SAD treatments. This review supports that neural correlates of SAD may be significant biomarkers for future pathophysiology based treatment.

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.

Cingulate-mediated approaches to treating chronic pain

Anterior midcingulate cortex (aMCC) has been shown to be involved in most of the functional imaging studies investigating acute pain. For 10-15 years, it has even been a main focus of interest for pain studies, considering that neurons in the aMCC could encode for pain intensity. This latter function is now presumed to occur in secondary somatosensory (SII) area and/or insular cortices, while anterior cingulate cortex (ACC) is supposed to sustain other functions such as pain-related attention, arousal, motor withdrawal reflex, pain modulations, and engagement of endogenous pain control system. The quantitative imaging studies have shown a rich density of opioid receptors in the ACC. Thus, the perigenual subdivision has been suggested to participate in top-down controls of pain, (including the placebo effects known to be opioid mediated), mainly (but not exclusively) through the connection between the orbitofrontal/subgenual ACC and the periaqueductal gray (PAG). From this rationale, this area may lead to neurosurgical targeting including electrical stimulation for intractable pain in the future. A number of imaging studies have also reported activity changes in the posterior cingulate cortex during pain and proposed its speculative involvement to modulate the conscious experience of pain according to elements from the context and awareness of the self and others.

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.

Autism, Early Psychosis, and Social Anxiety Disorder: a transdiagnostic examination of executive function cognitive circuitry and contribution to disability

The disability burden in clinical cohorts with social impairment is significant, leading to poor functional outcomes. Some of this impairment has been linked to executive dysfunction. In this study, a transdiagnostic approach was taken to identify executive function (EF) processes in young adults that may underpin social impairment and to evaluate their contribution to disability. Comparisons were made between three prominent disorders that are characterized by social impairments, Autism Spectrum Disorder (ASD), Early Psychosis (EP) and Social Anxiety Disorder (SAD), as well as a neurotypically developing group (TYP). We examined whether overall disability could be predicted by neuropsychological and self-report assessments of EF. Our study showed that ASD participants demonstrated impaired performance on most domains of EF compared to the TYP group (mental flexibility, sustained attention and fluency) while the EP group showed impairment on sustained attention and attentional shifting. The SAD participants showed EF impairment on self-report ratings, even though their objective performance was intact. Self-reports of EF explained a significant percentage (17%) of disability in addition to the variance explained by other predictors, and this was particularly important for ASD. This is the first study to compare EF measures across clinical groups of social impairment and suggests unique cognitive-circuitry that underpins disability within groups. Impairments in EF were broad in ASD and predicted disability, EP impairments were specific to attentional processes and SAD impairments likely relate to negative self-monitoring. Self-report, as opposed to performance-based EF, provided best capacity to predict disability. These findings contribute to transdiagnostic circuitry models and intervention strategies.

Oxytocin effects on self-referential processing: behavioral and neuroimaging evidence

Oxytocin (OT) influences other-oriented mental processes (e.g. trust and empathy) and the underlying neural substrates. However, whether and how OT modulates self-oriented processes and the underlying brain activity remains unclear. Using a double-blind, placebo-controlled between-subjects design, we manipulated memory encoding and retrieval of trait adjectives related to the self, a friend and a celebrity in a self-referential task in male adults. Experiment 1 (N = 51) found that OT vs placebo treatments reduced response times during encoding self-related trait adjectives but increased recognition scores of self-related information during memory retrieval. Experiment 2 (N = 50) showed similar OT effects on response times during encoding self-related trait adjectives. Moreover, functional magnetic resonance imaging (fMRI) results revealed that OT vs placebo treatments decreased the activity in the medial prefrontal cortex (MPFC) involved in encoding of self-related trait adjectives and weakened the coupling between the MPFC activity and a cultural trait (i.e. interdependence). Experiment 3 (N = 52) revealed that OT vs placebo treatments increased the right superior frontal activity during memory retrieval of self-related information. The results provide behavioral and fMRI evidence for OT effects on self-referential processing and suggest distinct patterns of OT modulations of brain activities engaged in encoding and retrieval of self-related information.

A mind full of self: Self-referential processing as a mechanism underlying the therapeutic effects of mindfulness training on internalizing disorders

The aim of the current review is to advance the hypothesis that change in self-referential processing is a key but under-examined mechanism through which mindfulness training confers its therapeutic benefits for individuals with internalizing disorders. Consequently, we integrated neuroscientific studies on aberrant self-referential processing in internalizing disorders with contemplative science scholarship examining the effects of mindfulness training on the self-referential system. Reviewing these literatures yielded four major conclusions: (1) internalizing disorders can be characterized by excessive self-referential processing and emotion dysregulation; (2) mindfulness training has moderate effects on reducing internalizing symptoms; (3) mindfulness training promotes the shifting from narrative self-focus to present-centered experiential awareness; (4) such mindfulness-induced changes in self-reference is accompanied by reduced activation in overactive self-referential brain regions that have been implicated in internalizing disorders. Clinical and research implications related to delineating the role of self-referential processing in producing the therapeutic effects of mindfulness training are discussed.

Neural correlates of conflict between gestures and words: A domain-specific role for a temporal-parietal complex

The interpretation of social cues is a fundamental function of human social behavior, and resolution of inconsistencies between spoken and gestural cues plays an important role in successful interactions. To gain insight into these underlying neural processes, we compared neural responses in a traditional color/word conflict task and to a gesture/word conflict task to test hypotheses of domain-general and domain-specific conflict resolution. In the gesture task, recorded spoken words ("yes" and "no") were presented simultaneously with video recordings of actors performing one of the following affirmative or negative gestures: thumbs up, thumbs down, head nodding (up and down), or head shaking (side-to-side), thereby generating congruent and incongruent communication stimuli between gesture and words. Participants identified the communicative intent of the gestures as either positive or negative. In the color task, participants were presented the words "red" and "green" in either red or green font and were asked to identify the color of the letters. We observed a classic "Stroop" behavioral interference effect, with participants showing increased response time for incongruent trials relative to congruent ones for both the gesture and color tasks. Hemodynamic signals acquired using functional near-infrared spectroscopy (fNIRS) were increased in the right dorsolateral prefrontal cortex (DLPFC) for incongruent trials relative to congruent trials for both tasks consistent with a common, domain-general mechanism for detecting conflict. However, activity in the left DLPFC and frontal eye fields and the right temporal-parietal junction (TPJ), superior temporal gyrus (STG), supramarginal gyrus (SMG), and primary and auditory association cortices was greater for the gesture task than the color task. Thus, in addition to domain-general conflict processing mechanisms, as suggested by common engagement of right DLPFC, socially specialized neural modules localized to the left DLPFC and right TPJ including adjacent homologous receptive language areas were engaged when processing conflicting communications. These findings contribute to an emerging view of specialization within the TPJ and adjacent areas for interpretation of social cues and indicate a role for the region in processing social conflict.

Happy heart, smiling eyes: A systematic review of positive mood effects on broadening of visuospatial attention

Positive mood contributes to mental and physical wellbeing. The broaden-and-build theory (Fredrickson, 2001) proposed that the beneficial effects of positive mood on life quality result from attentional broadening. In this article, we systematically review (following PRISMA guidelines; Moher et al., 2009), a host of studies investigating the nature and extent of attentional changes triggered by the experience of positive mood, with a focus on vision. While several studies reported a broadening of attention, others found that positive mood led to a more diffuse information processing style. Positive mood appears to lessen attention selectivity in a way that is context-specific and bound to limitations. We propose a new framework in which we postulate that positive mood impacts the balance between internally and externally directed attention, through modulations of cognitive control processes, instead of broadening attention per se. This novel model is able to accommodate discrepant findings, seeks to translate the phenomenon of the so-called broadening of attention with positive mood into functional terms, and provides plausible neurobiological mechanisms underlying this effect, suggesting a crucial role of the anterior and posterior cingulate cortex in this interaction.

Effects of Psychotherapy on Brain Activation Patterns in Anxiety Disorders

Abstract. Psychotherapy is an effective treatment for most mental disorders, including anxiety disorders. Successful psychotherapy implies new learning experiences and therefore neural alterations. With the increasing availability of functional neuroimaging methods, it has become possible to investigate psychotherapeutically induced neuronal plasticity across the whole brain in controlled studies. However, the detectable effects strongly depend on neuroscientific methods, experimental paradigms, analytical strategies, and sample characteristics. This article summarizes the state of the art, discusses current theoretical and methodological issues, and suggests future directions of the research on the neurobiology of psychotherapy in anxiety disorders.

Social anxiety disorder and the psychobiology of self-consciousness

Individuals with social anxiety disorder (SAD) are characterized by fear or anxiety about social situations, but also by important alterations in self-referential processing. Given advances in our understanding of the neurocircuitry and neurochemistry of SAD, the question arises of the relationship between this research and an emergent literature on the psychobiology of self and self-consciousness. A number of investigations of SAD have highlighted altered activity in the medial prefrontal cortex (mPFC; involved in self-representation), insula (involved in interoceptive processing), and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors (SSRI) and self-focused reappraisal in normalizing such changes. Future studies to more closely investigate associations between psychobiological alterations and changes in self-related processing in SAD, may be useful in shedding additional light on both SAD and self-consciousness.

Beyond emotions: A meta-analysis of neural response within face processing system in social anxiety

Patients with social anxiety disorder (SAD) experience anxiety and avoidance in face-to-face interactions. We performed a meta-analysis of functional magnetic resonance imaging (fMRI) studies in SAD to provide a comprehensive understanding of the neural underpinnings of face perception in this disorder. To this purpose, we adopted an innovative approach, asking authors for unpublished data. This is a common procedure for behavioral meta-analyses, which, however has never been used in neuroimaging studies. We searched Pubmed with the key words "Social Anxiety AND faces" and "Social Phobia AND faces." Then, we selected those fMRI studies for which we were able to obtain data for the comparison between SAD and healthy controls (HC) in a face perception task, either from the published papers or from the authors themselves. In this way, we obtained 23 studies (totaling 449 SAD and 424 HC individuals). We identified significant clusters in which faces evoked a higher response in SAD in bilateral amygdala, globus pallidus, superior temporal sulcus, visual cortex, and prefrontal cortex. We also found a higher activity for HC in the lingual gyrus and in the posterior cingulate. Our findings show that altered neural response to face in SAD is not limited to emotional structures but involves a complex network. These results may have implications for the understanding of SAD pathophysiology, as they suggest that a dysfunctional face perception process may bias patient person-to-person interactions.