Abstract
The fear of embarrassment and humiliation is the central element of social anxiety. This frequent condition is associated with cognitive biases indicating increased sensitivity to signals of social threat, which are assumed to play a causal role in the maintenance of social anxiety. Here, we employed laughter, a potent medium for the expression of acceptance and rejection, as an experimental stimulus in participants selected for varying degrees of social anxiety to identify cerebral mediators of cognitive biases in social anxiety using functional magnetic resonance imaging in combination with mediation analysis. We directly demonstrated that cerebral activation patterns within the dorsal attention network including the left dorsolateral and dorsomedial prefrontal cortex mediate the influence of social anxiety on laughter perception. This mediation proved to be specific for social anxiety after correction for measures of general state and trait anxiety and occurred most prominently under bimodal audiovisual laughter presentation when compared with monomodal auditory or visual laughter cues. Considering the possibility to modulate cognitive biases and cerebral activity by neuropsychological trainings, non-invasive electrophysiological stimulation and psychotherapy, this study represents a starting point for a whole line of translational research projects and identifies promising targets for electrophysiological interventions aiming to alleviate cognitive biases and symptom severity in social anxiety.
Highlights
Social anxiety (SA), in its core, is the fear of embarrassment and humiliation in social situations
The additional exploratory analyses of variance (ANOVA) did not reveal any significant interactions between the experimental factors and Liebowitz Social Anxiety Scale (LSAS) scores with regard to laughter ratings
This study focused on SA, the localization of cerebral structures mediating cognitive biases may be relevant for research on other psychiatric disorders as it has been shown that cognitive biases occur in other anxiety disorders as well as depression [58], schizophrenia [59] and addiction [60]
Summary
Social anxiety (SA), in its core, is the fear of embarrassment and humiliation in social situations. An attention bias with faster responses to socially threatening cues [5,6] and a negative interpretation bias for facial [7] and vocal [8] expressions are among the most well known cognitive biases in SA. These biases are thought to play a causal role in the maintenance of clinical anxiety [9,10]. Despite this assumed pivotal role of cognitive biases in SA, their neural underpinnings are still not well understood
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