A neutral face is not neutral even if you have not seen it: social anxiety disorder and affective priming with facial expressions

Cognitive theories suggest that social anxiety disorder (SAD) is characterized by biased processing of negative facial expressions. Recently, however, it has been proposed that the fear of positive evaluation may play an additional, important role. In order to investigate which specific expressions evoke biased processing, 15 patients diagnosed with SAD and 15 non-anxious controls (NACs) completed an affective priming procedure: they rated neutral symbols which were preceded by sub-optimally presented primes of angry, neutral, and smiling faces. Patients with SAD rated the symbols significantly more negatively than NACs when they were primed with a neutral face. In addition, SAD patients tended to rate all symbols significantly more negatively suggesting that all faces (negative, positive, and neutral) are threatening to SAD patients.