Neural Bases of Social Anxiety Disorder

Abstract

Context: Social anxiety disorder is thought to involve emotional hyperreactivity, cognitive distortions, and ineffective emotion regulation. While the neural bases of emotional reactivity to social stimuli have been described, the neural bases of emotional reactivity and cognitive regulation during social and physical threat, and their relationship to social anxiety symptom severity, have yet to be investigated. Objective: To investigate behavioral and neural correlates of emotional reactivity and cognitive regulation in patients and controls during processing of social and physical threat stimuli. Design: Participants were trained to implement cognitivelinguistic regulation of emotional reactivity induced by social (harsh facial expressions) and physical (violent scenes) threat while undergoing functional agnetic resonance imaging and providing behavioral ratings of negative emotion experience. Setting: Academic psychology department. Participants: Fifteen adults with social anxiety disorder and 17 demographically matched healthy controls. Main Outcome Measures: Blood oxygen level– dependent signal and negative emotion ratings. Results: Behaviorally, patients reported greater negative emotion than controls during social and physical threat but showed equivalent reduction in negative emotion following cognitive regulation. Neurally, viewing social threat resulted in greateremotion-relatedneuralresponsesin patients than controls, with social anxietysymptomseverity related to activity in anetworkofemotion-andattention-processing regions in patients only. Viewing physical threat produced nobetween-groupdifferences.Regulationduringsocialthreat resulted in greater cognitiveandattention regulation–related brain activation in controls compared with patients. Regulation during physical threat produced greater cognitive control–related response (ie, right dorsolateral prefrontal cortex) in patients compared with controls. Conclusions: Compared with controls, patients demonstrated exaggerated negative emotion reactivity and reduced cognitive regulation–related neural activation, specifically for social threat stimuli. These findings help to elucidate potential neural mechanisms of emotion regulation that might serve as biomarkers for nterventions for social anxiety disorder.