Abstract
BackgroundSocial anxiety disorder (SAD) is thought to involve deficits in emotion regulation, and more specifically, deficits in cognitive reappraisal. However, evidence for such deficits is mixed.MethodsUsing functional magnetic resonance imaging (fMRI) of blood oxygen-level dependent (BOLD) signal, we examined reappraisal-related behavioral and neural responses in 27 participants with generalized SAD and 27 healthy controls (HC) during three socio-emotional tasks: (1) looming harsh faces (Faces); (2) videotaped actors delivering social criticism (Criticism); and (3) written autobiographical negative self-beliefs (Beliefs).ResultsBehaviorally, compared to HC, participants with SAD had lesser reappraisal-related reduction in negative emotion in the Beliefs task. Neurally, compared to HC, participants with SAD had lesser BOLD responses in reappraisal-related brain regions when reappraising faces, in visual and attention related regions when reappraising criticism, and in the left superior temporal gyrus when reappraising beliefs. Examination of the temporal dynamics of BOLD responses revealed late reappraisal-related increased responses in HC, compared to SAD. In addition, the dorsomedial prefrontal cortex (DMPFC), which showed reappraisal-related increased activity in both groups, had similar temporal dynamics in SAD and HC during the Faces and Criticism tasks, but greater late response increases in HC, compared to SAD, during the Beliefs task. Reappraisal-related greater late DMPFC responses were associated with greater percent reduction in negative emotion ratings in SAD patients.ConclusionsThese results suggest a dysfunction of cognitive reappraisal in SAD patients, with overall reduced late brain responses in prefrontal regions, particularly when reappraising faces. Decreased late activity in the DMPFC might be associated with deficient reappraisal and greater negative reactivity.Trial registrationClinicalTrials.gov identifier: NCT00380731
Highlights
Social anxiety disorder (SAD) is thought to involve deficits in emotion regulation, and deficits in cognitive reappraisal
Brain responses: blood oxygen-level dependent (BOLD) signal magnitude Differential responses Compared to healthy controls (HC), patients had lesser reappraisal-related BOLD responses in the left inferior frontal gyrus (IFG), dorsal anterior cingulate cortex, and left lateral orbitofrontal cortex (LOFC) (Figure 2a)
Brain responses: BOLD signal magnitude Differential responses Compared to HC, patients had lesser reappraisal-related BOLD responses in bilateral fusiform gyrus, left lingual gyrus, left putamen, and right cerebellum (Figure 4a)
Summary
Social anxiety disorder (SAD) is thought to involve deficits in emotion regulation, and deficits in cognitive reappraisal. It has been suggested that patients with SAD use adaptive emotion regulation strategies, such as cognitive reappraisal, less frequently than non-anxious healthy adults [3]. Goldin and colleagues examined cognitive reappraisal of social (harsh facial expressions) and physical (violent scenes) threat in SAD patients and healthy controls. Regulation during social threat, but not physical threat, was associated with diminished recruitment of brain systems implicated in cognitive reappraisal (dorsomedial and dorsolateral prefrontal cortex (PFC)), and attention modulation (medial cuneus, posterior cingulate cortex, and parietal cortex) in SAD, compared to healthy controls [5]
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