Anxious Participants Research Articles

Social anxiety changes the way we move-A social approach-avoidance task in a virtual reality CAVE system.

Investigating approach-avoidance behavior regarding affective stimuli is important in broadening the understanding of one of the most common psychiatric disorders, social anxiety disorder. Many studies in this field rely on approach-avoidance tasks, which mainly assess hand movements, or interpersonal distance measures, which return inconsistent results and lack ecological validity. Therefore, the present study introduces a virtual reality task, looking at avoidance parameters (movement time and speed, distance to social stimulus, gaze behavior) during whole-body movements. These complex movements represent the most ecologically valid form of approach and avoidance behavior. These are at the core of complex and natural social behavior. With this newly developed task, the present study examined whether high socially anxious individuals differ in avoidance behavior when bypassing another person, here virtual humans with neutral and angry facial expressions. Results showed that virtual bystanders displaying angry facial expressions were generally avoided by all participants. In addition, high socially anxious participants generally displayed enhanced avoidance behavior towards virtual people, but no specifically exaggerated avoidance behavior towards virtual people with a negative facial expression. The newly developed virtual reality task proved to be an ecological valid tool for research on complex approach-avoidance behavior in social situations. The first results revealed that whole body approach-avoidance behavior relative to passive bystanders is modulated by their emotional facial expressions and that social anxiety generally amplifies such avoidance.

Generalization of extinction of a generalization stimulus in fear learning

Two experiments examined whether extinction of a generalization stimulus (GS) after single cue fear conditioning would in turn generalize to other stimuli, relative to a control group that received regular extinction of CS + itself. We found only a weak effect of such “generalization of GS extinction” either back to CS + or to a different GS, on either US expectancy or skin conductance measures. In other words, despite extinction trials with a stimulus highly similar to CS+, participants showed a return of fear when tested with CS + or a novel GS. However this responding declined rapidly over non-reinforced test trials. Trait anxious participants showed higher overall US expectancy ratings in the extinction and test phases, and slower extinction of expectancy, relative to low anxious participants. These results may help explain why exposure therapy, which is unlikely to reproduce the exact stimuli present at acquisition, sometimes fails to transfer to other fear-eliciting stimuli subsequently encountered by anxious clients. The generalization of GS extinction paradigm might provide a useful testbed for evaluation of interventions designed to enhance transfer, such as exposure to multiple diverse exemplars.

Functional divergence of two threat-induced emotions: Fear-based versus anxiety-based cybersecurity preferences.

Two threat-induced emotions and their respective ability to sway cybersecurity preferences were investigated after a cyberattack on financial institutions. Our theoretical aim was to advance the functionalist claim and differentiate between fear and anxiety by their action tendencies. The emotions were expected to have unique motivation power and thus show mutually exclusive ties to the three types of safety behaviors emerged in our study. Avoidance would be uniquely embraced by fearful participants, whereas surveillance and vigilance would uniquely appeal to anxious participants. Study 1 (N = 199) used a cross-sectional design and found full support for the hypothesis regarding anxiety but only partial support for the hypothesis regarding fear. Study 2 (N = 304), an experiment of fearful, anxious, and relaxed groups, did not yield significant results but did offer methodological recommendations. The quasi-experiments in Study 3 (N = 120) and Study 4 (N = 156) supported the hypotheses on fear and anxiety. Our results in the novel domain of cyber threat brought new evidence to bear on the mixed literature on fear and anxiety. A discussion is offered on the methodological challenges of differentiating two closely related emotions as well as implications for the emerging debate of cybersecurity solutions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Wearing a bike helmet leads to less cognitive control, revealed by lower frontal midline theta power and risk indifference.

A recent study claims that participants wearing a bike helmet behave riskier in a computer-based risk task compared to control participants without a bike helmet. We hypothesized that wearing a bike helmet reduces cognitive control over risky behavior. To test our hypothesis, we recorded participants' EEG brain responses while they played a risk game developed in our laboratory. Previously, we found that, in this risk game, anxious participants showed greater levels of cognitive control as revealed by greater frontal midline theta power, which was associated with less risky decisions. Here, we predicted that cognitive control would be reduced in the helmet group, indicated by reduced frontal midline theta power, and that this group would prefer riskier options in the risk game. In line with our hypothesis, we found that participants in the helmet group showed significantly lower frontal midline theta power than participants in the control group, indicating less cognitive control. We did not replicate the finding of generally riskier behavior in the helmet group. Instead, we found that participants chose the riskier option in about half of trials, no matter how risky the other option was. Our results suggest that wearing a bike helmet reduces cognitive control, as revealed by reduced frontal midline theta power, leading to risk indifference when evaluating potential behaviors.

A human subcortical network underlying social avoidance revealed by risky economic choices.

Social interactions have a major impact on well-being. While many individuals actively seek social situations, others avoid them, at great cost to their private and professional life. The neural mechanisms underlying individual differences in social approach or avoidance tendencies are poorly understood. Here we estimated people's subjective value of engaging in a social situation. In each trial, more or less socially anxious participants chose between an interaction with a human partner providing social feedback and a monetary amount. With increasing social anxiety, the subjective value of social engagement decreased; amygdala BOLD response during decision-making and when experiencing social feedback increased; ventral striatum BOLD response to positive social feedback decreased; and connectivity between these regions during decision-making increased. Amygdala response was negatively related to the subjective value of social engagement. These findings suggest a relation between trait social anxiety/social avoidance and activity in a subcortical network during social decision-making.

Men Scare Me More: Gender Differences in Social Fear Conditioning in Virtual Reality.

Women nearly twice as often develop social anxiety disorder (SAD) compared to men. The reason for this difference is still being debated. The present study investigates gender differences and the effect of male versus female agents in low (LSA) and high socially anxious (HSA) participants regarding the acquisition and extinction of social fear in virtual reality (VR). In a social fear conditioning (SFC) paradigm, 60 participants actively approached several agents, some of which were paired with an aversive unconditioned stimulus (US) consisting of a verbal rejection and spitting simulated by an aversive air blast (CS+), or without an US (CS−). Primary outcome variables were defined for each of the 4 levels of emotional reactions including experience (fear ratings), psychophysiology (fear-potentiated startle), behavior (avoidance), and cognition (recognition task). Secondary outcome variables were personality traits, contingency ratings, heart rate (HR), and skin conductance response (SCR). As hypothesized, fear ratings for CS+ increased significantly during acquisition and the differentiation between CS+ and CS− vanished during extinction. Additionally, women reported higher fear compared to men. Furthermore, a clear difference in the fear-potentiated startle response between male CS+ and CS− at the end of acquisition indicates successful SFC to male agents in both groups. Concerning behavior, results exhibited successful SFC in both groups and a general larger distance to agents in HSA than LSA participants. Furthermore, HSA women maintained a larger distance to male compared to female agents. No such differences were found for HSA men. Regarding recognition, participants responded with higher sensitivity to agent than object stimuli, suggesting a higher ability to distinguish the target from the distractor for social cues, which were on focus during SFC. Regarding the secondary physiological outcome variables, we detected an activation in HR response during acquisition, but there were no differences between stimuli or groups. Moreover, we observed a gender but no CS+/CS− differences in SCR. SFC was successfully induced and extinguished according to the primary outcome variables. VR is an interesting tool to measure emotional learning processes on different outcome levels with enhanced ecological validity. Future research should further investigate social fear learning mechanisms for developing more efficient treatments of SAD.

Cross-species convergence in pupillary response: understanding human anxiety via non-human primate amygdala lesion.

Few studies have used matched affective paradigms to compare humans and non-human primates. In monkeys with amygdala lesions and youth with anxiety disorders, we examined cross-species pupillary responses during a saccade-based, affective attentional capture task. Given evidence of enhanced amygdala function in anxiety, we hypothesized that opposite patterns would emerge in lesioned monkeys and anxious participants. A total of 53 unmedicated youths (27 anxious, 26 healthy) and 8 adult male rhesus monkeys (Macaca mulatta) completed matched behavioral paradigms. Four monkeys received bilateral excitotoxic amygdala lesions and four served as unoperated controls. Compared to healthy youth, anxious youth exhibited increased pupillary constriction in response to emotional and non-emotional distractors (F(1,48) = 6.28, P=0.02, η2p= 0.12). Pupillary response was associated significantly with anxiety symptoms severity (F(1,48) = 5.59, P=0.02, η2p= 0.10). As hypothesized, lesioned monkeys exhibited the opposite pattern i.e. decreased pupillary constriction in response to distractors, compared to unoperated control monkeys (F(1,32) = 24.22, P<0.001, η2= 0.33). Amygdala lesioned monkeys and youth with anxiety disorders show opposite patterns of pupil constriction in the context of an affective distractor task. Such findings suggest the presence of altered amygdala circuitry functioning in anxiety. Future lesion and human neuroimaging work might examine the way in which specific amygdala sub-nuclei and downstream circuits mediate these effects.

Associations Between Approach and Avoidance Coping, Psychological Distress, and Disordered Eating Among Candidates for Bariatric Surgery

Individuals seeking bariatric surgery evidence risk for binge and disordered eating behaviors, which can lead to poorer post-surgical weight loss outcomes. Use of avoidant coping strategies to manage stress, along with symptoms of depression, are associated with disordered eating in the general population. However, the role of coping has not been examined among candidates for bariatric surgery, and coping and depression have rarely been considered in combination. Given the emerging standard that psychologists are involved in evaluations and treatment before and after surgery, consideration of these variables is clinically relevant. Participants were 399 patients undergoing pre-surgical bariatric psychological assessment. Hierarchical linear regression analyses tested whether gender, age, and BMI; approach and avoidance coping; and depression and anxiety were associated with disordered eating (binge eating, restraint, eating concerns, shape concerns, weight concerns) in a cross-sectional study design. In initial steps of the model controlling demographic variables, approach coping predicted less and avoidance coping predicted more disordered eating across most outcomes examined. In models including depression and anxiety, avoidance (but not approach) coping remained a relevant predictor. The effects of depression were also quite robust, such that participants who were more depressed reported more disordered eating. More anxious participants reported more restrained eating. Avoidance coping and depressive symptoms emerged as key variables in understanding recent disordered eating among patients considering bariatric surgery. Pre-surgical psychological evaluations and treatment approaches could be enhanced with consideration of patient coping strategies, particularly avoidant coping responses to stress, independent of psychological distress.

Attentional bias modification in social anxiety: Effects on the N2pc component

Several meta-analyses to date have confirmed the efficacy of attentional bias modification (ABM) in shifting reaction times away from threatening stimuli, reducing anxiety symptoms, and buffering against stressor vulnerability. The reliability of reaction time differences, however, has been found to show unacceptable psychometric properties. In this study, we tested the impact of an extensive Dot-Probe ABM procedure, consisting of close to 7000 trials, concurrently with behavioral and electrophysiological measures within a large sample of over 100 highly socially anxious participants. Results indicated that the N2pc component demonstrates superior internal consistency and more statistical power in detecting attentional biases and their modification than reaction time (RT) differences. RTs were neither indicative of an attentional bias before ABM nor of a modification over time. In contrast, the N2pc indexed both an initial attentional preference for threatening stimuli and an alteration of this relationship after training. Outcomes were not specific for attentional training away from threat but also occurred in the no-contingency control procedure, casting doubt on the theoretic underpinnings of ABM. Electrophysiological measures are an important complement to the ABM literature and should be further utilized to assess attentional biases with excellent reliability.

Adaptive working memory training can reduce anxiety and depression vulnerability in adolescents.

Adolescents can be at heightened risk for anxiety and depression, with accumulating research reporting on associations between anxiety and depression and cognitive impairments, implicating working memory and attentional control deficits. Several studies now point to the promise of adaptive working memory training to increase attentional control in depressed and anxious participants and reduce anxiety and depression symptoms, but this has not been explored in a non-clinical adolescent population. The current study explored the effects of adaptive dual n-back working memory training on sub-clinical anxiety and depression symptomology in adolescents. Participants trained on either an online adaptive working memory task or non-adaptive control task for up to 20days. Primary outcome measures were self-reported anxiety and depression symptomology, before and after intervention, and at 1-month follow-up. Self-reported depression (p=0.003) and anxiety (p=0.04) decreased after training in the adaptive n-back group relative to the non-adaptive control group in the intention-to-treat sample (n=120). These effects were sustained at follow-up. Our findings constitute proof of principle evidence that working memory training may help reduce anxiety and depression vulnerability in a non-clinical adolescent population. We discuss the findings' implications for reducing risk of internalizing disorders in youth and the need for replication.

Mathematics Anxiety and Metacognitive Processes

This paper presents a proposal for a new area of investigation that connects the metacognition literature, and especially the recently developed meta-reasoning framework, with research into mathematical reasoning, mathematics learning, and mathematics anxiety. Whereas the literature on mathematics anxiety focusses on the end result of learning and problem-solving, the metacognitive approach can offer further insight by a fine-grained analysis of the stages of these processes. In particular, it provides tools for exposing students' initial assessment of tasks and test situations, the targets they set for themselves, the process of monitoring progress, and decisions to stick with or abandon a particular solution. The paper outlines various ways in which the metacognitive approach could be used to investigate the effects of mathematics anxiety on mathematics learning and problem solving. This approach could help in answering questions like: Do anxious and non-anxious learners differ in how they prepare for an exam? Are anxious students more or less prone to overconfidence than non-anxious students? What metacognitive decisions mediate maths anxious participants' tendency to give up on problems too early? Additionally, this line of work has the potential to significantly expand the scope of metacognitive investigations and provide novel insights into individual differences in the metacognitive regulation of learning and problem solving. It could also offer some practical benefits by focusing the attention of educational designers on particular components within the learning process of anxious students.

Attentional bias towards angry faces is moderated by the activation of a social processing mode in the general population

ABSTRACTDot-probe studies usually find an attentional bias towards threatening stimuli only in anxious participants, but not in non-anxious participants. In the present study, we conducted two experiments to investigate whether attentional bias towards angry faces in unselected samples is moderated by the extent to which the current task requires social processing. In Experiment 1, participants performed a dot-probe task involving classification of either socially meaningful targets (schematic faces) or meaningless targets (scrambled schematic faces). Targets were preceded by two photographic face cues, one angry and one neutral. Angry face cues only produced significant cueing scores (i.e. faster target responses if the target replaced the angry face compared to the neutral face) with socially meaningful targets, not with meaningless targets. In Experiment 2, participants classified only meaningful targets, which were either socially meaningful (schematic faces) or not (schematic houses). Again, mean cueing scores were significantly moderated by the social character of the targets. However, cueing scores in this experiment were non-significant in the social target condition and significantly negative in the non-social target condition. These results suggest that attentional bias towards angry faces in the dot-probe task is moderated by the activation of a social processing mode in unselected samples.

Post-event processing in social anxiety: Investigation using Attentional Control Theory

Post-event processing has been identified as a maladaptive maintaining feature of social anxiety occurring after a social-evaluative event; however, the cognitive mechanisms thought to underlie post-event processing are still unclear. Poor attentional control may serve to maintain this thought process in social anxiety disorder. A total of 92 undergraduates were pre-screened and categorised into either high or low social anxiety groups and then randomly assigned to either a post-event processing (following a speech task) or a control condition (four groups in total). Participants completed a series of self-report questionnaires and then performed the mixed emotional saccade task whereby participants completed pro-saccades and antisaccades in response to facial expressions in either single-task or mixed-task blocks. The results showed that high socially anxious participants in the post-event processing condition did not display attentional control impairments compared to high socially anxious participants in the control condition or low socially anxious participants in either condition. Conversely, low socially anxious participants in the post-event processing condition showed improved attentional control abilities compared to low socially anxious participants in the control condition. These findings suggest that post-event processing may facilitate attentional control abilities for low socially anxious individuals.

Impacts of Mindfulness-Based Cognitive Therapy (MBCT) on the Psychological and Functional Wellbeing of Patients with Bipolar Disorders

Background: This time series analysis investigated variations in psychic and somatic anxiety during and after completion of MBCT compared to baseline in patients diagnosed with BD. Secondary variables considered were sleep quality and quality of life, as well as depressive and manic symptoms. Methods: HAMD-29, HAMD-7 and YMRS were administered at baseline (n=34), and every two weeks until the end of the eight-week program. PSQI (n=22) and Q-LES-Q-SF (n=29) were also administered at pre, mid- and post- MBCT assessments. Results: Twenty-four (n=24) participants completed at least four out the eight sessions of MBCT. Post-intervention relative to baseline, psychic anxiety dropped largely (Cohen d=0.74), whilst somatic anxiety remained unchanged (Cohen d=-0.01). In subgroups based on pre-MBCT mental status (anxious/non-anxious, depressed/non-depressed), anxious participants sustained a very strong decline in anxiety (Cohen d=1.67), enough so that they no longer differed from non-anxious participants post-MBCT (p=0.261). A similar post-MBCT convergence was observed between depressed vs. non-depressed participants at baseline (Cohen d=1.03). A slight surge of depressive, anxious, and manic symptoms was noted at Week 6. Sleep quality and quality of life improved post-MBCT relative to baseline with a moderate effect size (Cohen d=0.57 and 0.70, respectively). Conclusions: BD diagnosed participants with more symptoms of anxiety and depression at baseline appeared to benefit the most from MBCT. A strong effect on psychic anxiety was found, but none on somatic anxiety. Better sleep quality and quality of life were observed. Manic symptoms improved slightly. More research, especially randomized control trials, are warranted.

A Double-Blind Placebo Controlled Study of Intranasal Oxytocin's Effect on Emotion Recognition and Visual Attention in Outpatients with Emotional Disorders.

The current study used double-blind, placebo-controlled design to examine the effect of intranasal oxytocin (OT) on emotion recognition (ER) and visual attention in 60 outpatients presenting for assessment and treatment of emotional disorders. Our primary hypothesis was that OT would improve recognition of happy faces in depressed participants. The main effect of OT on ER accuracy, speed, and proportion of fixations in the eye region was not significant. Diagnostic group (i.e., presence/absence of a depressive disorder) moderated the effect of OT on ER, but not as expected: OT significantly slowed ER speed for all emotions in participants with anxiety disorders, but did not affect performance in participants with depressive disorders. Depressed participants fixated significantly less in the eye region of sad faces than anxious participants. Before OT can be used to target ER biases, additional research is needed to explicate the differential impact of OT on ER speed in patients with anxiety versus mood disorders.

Inhibitory attentional control in anxiety: Manipulating cognitive load in an antisaccade task.

Theorists have proposed that heightened anxiety vulnerability is characterised by reduced attentional control performance and have made the prediction in turn that elevating cognitive load will adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Critically however, existing attempts to test this prediction have been limited in their methodology and have presented inconsistent findings. Using a methodology capable of overcoming the limitations of previous research, the present study sought to investigate the effect of manipulating cognitive load on inhibitory attentional control performance of high anxious and low anxious individuals. High and low trait anxious participants completed an antisaccade task, requiring the execution of prosaccades towards, or antisaccades away from, emotionally toned stimuli while eye movements were recorded. Participants completed the antisaccade task under conditions that concurrently imposed a lesser cognitive load, or greater cognitive load. Analysis of participants’ saccade latencies revealed high trait anxious participants demonstrated generally poorer inhibitory attentional control performance as compared to low trait anxious participants. Furthermore, conditions imposing greater cognitive load, as compared to lesser cognitive load, resulted in enhanced inhibitory attentional control performance across participants generally. Crucially however, analyses did not reveal an effect of cognitive load condition on anxiety-linked differences in inhibitory attentional control performance, indicating that elevating cognitive load did not adversely impact attentional control performance for high anxious individuals to a greater degree than low anxious individuals. Hence, the present findings are inconsistent with predictions made by some theorists and are in contrast to the findings of earlier investigations. These findings further highlight the need for research into the relationship between anxiety, attentional control, and cognitive load.

Antenatal Anxiety: Prevalence and Patterns in a Routine Obstetric Population

Expectant mothers may appear anxious even during healthy pregnancies. Unfortunately, little is known about antenatal anxiety, and affected women may remain undetected and untreated. This study aimed to examine the prevalence, incidence, course and associations of high state anxiety in routine obstetric care. This was an observational prospective cohort study at a large maternity unit. Obstetric outpatients with low-risk singleton pregnancies were recruited during first trimester consultations. Participants provided sociodemographic data and completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale. The STAI was re-administered at each subsequent trimester. Prevalence and incidence of high state anxiety among 634 completers were 29.5% (95% CI 25.6%-33.6%) and 13.9% (95% CI 9.9%-18.0%), respectively. Anxiety was persistent in 17.0% (95% CI 14.3%-20.2%) and transient in 26.3% (95% CI 23.1%-29.9%). Only persistently anxious participants had high mean second trimester state anxiety scores. Odds for anxiety of greater persistence increased by 29% (95% CI 24%-35%) per 1-point increase in first trimester depression scores, and decreased by 36% (95% CI 7%-56%) with tertiary education. Antenatal anxiety symptoms are common even in normal pregnancies, especially among women with depression and lower education. Our study indicates value in exploring diagnostic criteria and quantitative measures for antenatal anxiety.

Verbal instructions override the meaning of facial expressions

Psychological research has long acknowledged that facial expressions can implicitly trigger affective psychophysiological responses. However, whether verbal information can alter the meaning of facial emotions and corresponding response patterns has not been tested. This study examined emotional facial expressions as cues for instructed threat-of-shock or safety, with a focus on defensive responding. In addition, reversal instructions were introduced to test the impact of explicit safety instructions on fear extinction. Forty participants were instructed that they would receive unpleasant electric shocks, for instance, when viewing happy but not angry faces. In a second block, instructions were reversed (e.g., now angry faces cued shock). Happy, neutral, and angry faces were repeatedly presented, and auditory startle probes were delivered in half of the trials. The defensive startle reflex was potentiated for threat compared to safety cues. Importantly, this effect occurred regardless of whether threat was cued by happy or angry expressions. Although the typical pattern of response habituation was observed, defense activation to newly instructed threat cues remained significantly enhanced in the second part of the experiment, and it was more pronounced in more socially anxious participants. Thus, anxious individuals did not exhibit more pronounced defense activation compared to less anxious participants, but their defense activation was more persistent.

Social anxiety and employment interviews: does nonverbal feedback differentially predict cortisol and performance?

ABSTRACTBackground & Objectives: Interviewers often provide positive nonverbal feedback to reduce interviewees’ anxiety. Socially anxious individuals typically harbor negative self-views discrepant with positive feedback. We examined whether nonverbal feedback and social anxiety jointly influence cortisol responses to, and performance during, interviews.Design: An experimental between-subjects design randomly assigned participants to feedback condition.Methods: Undergraduate students (N = 130) provided saliva and completed social anxiety, interview anxiety, and affective measures before a simulated interview. Following a standardized script, a confederate interviewer provided positive, ambiguous, or negative nonverbal feedback. Participants then provided saliva and completed self-focused attention and self-awareness measures. Confederate interviewers and an external rater evaluated participants’ anxiety displays, assertive behavior, and performance.Results: Positive feedback decreased cortisol and improved performance for low social anxiety participants. Socially anxious participants exhibited higher cortisol but did not exhibit significant differences in performance after positive compared to negative feedback.Conclusions: Consistent with previous findings, positive feedback did not benefit socially anxious interviewees. Positive feedback increased physiological arousal relative to negative feedback but did not hinder performance among people high in social anxiety. These results provide novel information about the interactive influence of social anxiety and nonverbal interviewer feedback on arousal, self-focus, and interview performance.

Height Simulation in a Virtual Reality CAVE System: Validity of Fear Responses and Effects of an Immersion Manipulation.

Acrophobia is characterized by intense fear in height situations. Virtual reality (VR) can be used to trigger such phobic fear, and VR exposure therapy (VRET) has proven effective for treatment of phobias, although it remains important to further elucidate factors that modulate and mediate the fear responses triggered in VR. The present study assessed verbal and behavioral fear responses triggered by a height simulation in a 5-sided cave automatic virtual environment (CAVE) with visual and acoustic simulation and further investigated how fear responses are modulated by immersion, i.e., an additional wind simulation, and presence, i.e., the feeling to be present in the VE. Results revealed a high validity for the CAVE and VE in provoking height related self-reported fear and avoidance behavior in accordance with a trait measure of acrophobic fear. Increasing immersion significantly increased fear responses in high height anxious (HHA) participants, but did not affect presence. Nevertheless, presence was found to be an important predictor of fear responses. We conclude that a CAVE system can be used to elicit valid fear responses, which might be further enhanced by immersion manipulations independent from presence. These results may help to improve VRET efficacy and its transfer to real situations.