Gaze avoidance in social phobia: Objective measure and correlates

Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder.     

Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia

This study examined significant others' expressed emotion (EE) and a closely related construct, perceived criticism, as predictors of cognitive-behavioral therapy outcome in a sample of 40 patients with social phobia (social anxiety disorder). Patients enrolled in group therapy for social phobia completed pre- and post-treatment questionnaire measures of perceived criticism and anxious and depressive symptoms. Designated significant others were assessed for the components of high EE (criticism, hostility and emotional overinvolvement) using the Camberwell Family Interview. It was hypothesized that these high-EE components and patients' perceived criticism would be associated with poorer treatment outcome, and results ran counter to these expectations. Controlling for initial social phobia severity, lower levels of perceived criticism predicted treatment dropout. There was also a nonsignificant trend for participants with a significant other rated as high in emotional overinvolvement to show less change on a composite symptom measure. Findings from this study suggest that close relationships impact the outcome of cognitive-behavioral interventions for social phobia.     

Neurobiology of social phobia

Social phobia is an anxiety disorder that is characterized by excessive fear and/or avoidance of situations in which an individual believes that he or she may be the subject of evaluation or scrutiny while interacting with other people or performing a specific task. This article reviews the available literature on the neurobiology underlying social phobia, including autonomic nervous system effects, neuroimaging findings, pharmacologic challenge studies, and neuroendocrine responsivity and function. Overall, such studies have found few consistently demonstrable differences in neurobiology between patients with social phobia and healthy controls, but further investigations are needed.     

Cognitive features of social phobia

New cognitive models of social phobia have been developed based, in part, on a growing number of studies suggesting that people with social phobia process information related to social threat differently than people who are not socially anxious and, in some cases, differently than individuals with other anxiety disorders. In addition to providing an overview of recent models of social phobia, this paper reviews the research literature to date on the following aspects of cognition in social phobia: attention, memory, attributions and appraisals, imagery and perspective, and perfectionism.     

Framing social information and generalized social phobia

Patients with generalized social phobia (GSP, N=33) and matched community controls (N=31) engaged in a social interaction that was constructed to go well, and then received feedback that framed social cues reflecting either the absence of negative outcomes or the presence of positive outcomes. Following feedback that framed positive social cues, the GSP group predicted they would experience more anxiety in a subsequent interaction than did non-phobic controls. In contrast, following feedback framing the absence of negative outcomes, the GSP group did not differ from controls in their anxiety predictions. The results demonstrated that framing paradigms and methods can be usefully applied to the study of cognitive processes in social phobia and indicated that research to examine how GSP patients process specific types of social information is needed.     

Neurofunctional correlates of personality traits in relapsing-remitting multiple sclerosis: An fMRI study

Extraversion and Neuroticism are two fundamental dimensions of human personality that influence cognitive functioning in healthy subjects. Little is known about personality changes that may occur in patients with multiple sclerosis (MS) nor about, in particular, their neurofunctional basis. The aim of this study is to determine the impact of personality characteristics on brain activity in patients with MS. Eighteen patients with clinically definite relapsing-remitting MS without any evidence of psychiatric or cognitive disorders and thirteen healthy controls matched for age, gender and education were investigated using functional magnetic resonance imaging (fMRI) during the execution of an “n-back” task. No differences were detected on the behavioral tests between the two groups, although the MS patients had lower total IQ and showed a trend towards higher Extraversion and Neuroticism scores than did the controls. fMRI analyses demonstrated that Extraversion scores were positively associated with brain activity in the fronto-parietal network including the superior parietal lobule and dorsolateral prefrontal cortex in both groups during the high load condition of the n-back task. Given the overlapping neural systems found in the two groups, we suggest that the neural activity associated with specific personality dimension is a neurophysiological characteristic preserved in patients with MS at an early stage in the course of their disease.     

Neurofunctional correlates of personality traits in relapsing-remitting multiple sclerosis: An fMRI study

Extraversion and Neuroticism are two fundamental dimensions of human personality that influence cognitive functioning in healthy subjects. Little is known about personality changes that may occur in patients with multiple sclerosis (MS) nor about, in particular, their neurofunctional basis. The aim of this study is to determine the impact of personality characteristics on brain activity in patients with MS. Eighteen patients with clinically definite relapsing-remitting MS without any evidence of psychiatric or cognitive disorders and thirteen healthy controls matched for age, gender and education were investigated using functional magnetic resonance imaging (fMRI) during the execution of an “n-back” task. No differences were detected on the behavioral tests between the two groups, although the MS patients had lower total IQ and showed a trend towards higher Extraversion and Neuroticism scores than did the controls. fMRI analyses demonstrated that Extraversion scores were positively associated with brain activity in the fronto-parietal network including the superior parietal lobule and dorsolateral prefrontal cortex in both groups during the high load condition of the n-back task. Given the overlapping neural systems found in the two groups, we suggest that the neural activity associated with specific personality dimension is a neurophysiological characteristic preserved in patients with MS at an early stage in the course of their disease.     

Psychosocial treatments for social phobia

Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.     

Interpretation and judgmental biases in social phobia

Previous research demonstrated that social phobia is characterized by content-specific interpretation and judgmental biases. The present study investigated whether this interpretation bias occurs not only in ambiguous, but also in positive and negative social events, and whether social phobic patients (SPs) are more characterized by a judgmental bias in costs than in probability. Besides, we argued that the judgmental bias observed in former studies could also be attributed to accurate estimations of SPs (of, for example, stuttering). Therefore, we assessed judgmental bias by the ratings of probability and costs of a negative evaluation (e.g. ‘people dislike me’) and not, as in previous studies, of negative social events (e.g. ‘stuttering’). SPs (n=228) and normal controls (n=33) were presented social and non-social events ranging from positive to profoundly negative. They ranked four different interpretations on likelihood to assess interpretation bias, and rated the profoundly negative interpretation on probability and cost to assess judgmental bias. SPs demonstrated content-specific interpretation and judgmental biases that also occurred in positive and negative social events. In contrast with expectations, SPs were characterized by a judgmental bias in both costs and probability.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM-IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non-clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co-morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Deficits in perceived social support associated with generalized social phobia

Social phobia is a common anxiety disorder associated with significant impairment in social and occupational functioning. To date, few studies have examined the relationship between social phobia and perceived social support, a construct with important relationships to physical and mental health. The present study examined data from 2 widely used measures of perceived social support administered to 132 individuals with DSM‐IV generalized social phobia. These data were compared with those obtained from a healthy control group and from several clinical and non‐clinical samples reported in the literature. Persons with generalized social phobia scored significantly lower on both measures of social support compared with all other groups. It is suggested that deficits in perceived social support associated with generalized social phobia may play a role in the development of co‐morbid problems and should be explicitly targeted by treatments for social phobia. Low correlations between perceived social support and social anxiety measures suggest that perceived support should be specifically evaluated in this population.     

Working memory capacity in generalized social phobia

Research suggests that understanding complex social cues depends on the availability of cognitive resources (e.g., Phillips, Channon, Tunstall, Hedenstrom, & Lyons, 2008). In spite of evidence suggesting that executive control functioning may impact anxiety (e.g., Eysenck, Derakshan, Santos, & Calvo, 2007), relatively few studies have examined working memory in individuals with generalized social phobia. Moreover, few studies have examined the role of threat-relevant content in working memory performance in clinically anxious populations. To this end, the present study assessed working memory capacity (WMC) in individuals with generalized social phobia and nonanxious controls using an operation span task with threat-relevant and neutral stimuli. Results revealed that nonanxious individuals demonstrated better WMC than individuals with generalized social phobia for neutral words but not for social threat words. Individuals with generalized social phobia demonstrated better WMC performance for threat words relative to neutral words. These results suggest that individuals with generalized social phobia may have relatively enhanced working memory performance for salient, socially relevant information. This enhanced working memory capacity for threat-relevant information may be the result of practice with this information in generalized social phobia.     

Blushing and physiological arousability in social phobia

Blushing is the most prominent symptom of social phobia, and fear perception of visible anxiety symptoms is an important component of cognitive behavioral models of social phobia. However, it is not clear how physiological and psychological aspects of blushing and other somatic symptoms are linked in this disorder. The authors tested whether social situations trigger different facial blood volume changes (blushing) between social phobic persons with and without primary complaint of blushing and control participants. Thirty social phobic persons. 15 of whom were especially concerned about blushing, and 14 control participants were assessed while watching an embarrassing videotape, holding a conversation, and giving a talk. Only when watching the video did the social phobic persons blush more than controls blushed. Social phobic persons who complained of blushing did not blush more intensely than did social phobic persons without blushing complaints but had higher heart rates, possibly reflecting higher arousability of this subgroup.     

Memory for facial expressions in social phobia

Memory biases toward threat have been documented in several anxiety disorders, but contradictory findings have recently been reported in social phobics' recognition of facial expressions. The present study examined recognition memory in clients with social phobia, in an effort to clarify previous inconsistent results. Just before giving a speech to a live audience, social phobia clients and normal controls viewed photographs of people with reassuring and threatening facial expressions. The stimuli were later presented again alongside photographs of the same person with a different facial expression, and participants chose which face they had seen before. Individuals with social phobia were less accurate at recognizing previously seen photographs than controls, apparently due to state anxiety. In contrast, social phobics did not show a memory bias toward threatening facial expressions. Theoretical and treatment implications are discussed.     

Impaired positive inferential bias in social phobia

People with social phobia report anticipatory and retrospective judgments about social situations that appear consistent with a negative interpretative bias. However, it is not at all clear that biased interpretative inferences are made "on-line;" that is, at the time that ambiguous information is first encountered. In a previous study, volunteers who were anxious about interviews were found to lack the positive on-line inferential bias that was characteristic of nonanxious controls but also failed to show a bias favoring threatening inferences (C. R. Hirsch & A. Mathews, 1997). This finding was confirmed in the present study, in which social phobic patients showed no evidence of making on-line emotional inferences, in contrast with socially nonanxious controls who were again clearly biased in favor of positive inferences. The authors concluded that nonanxious individuals are characterized by a benign on-line inferential bias, but that this is impaired in people with social phobia.     

Interpretations for anxiety symptoms in social phobia

This study explored the ways in which people interpret visible physical symptoms of anxiety. A group of participants with social phobia (SP) and a nonclinical control (NCC) group completed either the Actor version or the Observer version of the Symptom Interpretation Scale (SIS), designed for the purposes of this study. The SIS asks participants to rate the extent to which each of eight interpretations is a likely explanation for a number of visible symptoms of anxiety. On the Actor version of the SIS, participants are asked to judge how their own anxiety symptoms are interpreted by others. On the Observer version of the SIS, participants are asked how they typically interpret anxiety symptoms that they notice in others. When participants were asked about anxiety symptoms that they themselves exhibit, people with social phobia were more likely than nonclinical controls to think that others interpreted these symptoms as being indicative of intense anxiety or a psychiatric condition and were less likely to think that others interpreted these symptoms as being indicative of a normal physical state. Data also suggested that people with social phobia have a more flexible cognitive style when asked to interpret anxiety symptoms exhibited by others than when asked about how others view their own anxiety symptoms. These findings are discussed in the context of recent psychological models of social anxiety and social phobia.