Social Anxiety Disorder Group Research Articles

Self esteem and clinical features in a clinical sample of children with ADHD and social anxiety disorder

Objective In this study, we aimed to investigate self-esteem and clinical features in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and comorbid Social Anxiety Disorder (SAD) and compare these to children and adolescents without SAD. Methods One hundred and twenty child and adolescent drug-naïve outpatients (6–15 years of age) with a primary diagnosis of ADHD were included. Schedule for Affective Disorders and Schizophrenia for School Age Children–Present and Lifetime Version (K-SADS-PL), was used to evaluate ADHD and comorbidities. Parents filled in clinical and sociodemographic data form, Conners Parent Rating Scale (CPRS) and patients filled in Rosenberg Self-esteem Scale (RSES) and Çapa Social Phobia Scale for children and adolescents (ÇESFÖ). Results Forty-six of the 120 (38.3%) children had comorbid SAD. Forty-six patients with SAD (ADHD + SAD group) and 74 patients without SAD (ADHD without SAD group) were compared in terms of the sociodemographic and clinical features, rate of psychiatric comorbidities, and rating scale scores. The rate of inattentive subtype of ADHD (p = 0.009), and social anxiety symptom scores (p < 0.001) were higher and self-esteem was lower (p < 0.001) in the ADHD + SAD group. Additionally, there was a statistically significant correlation between ÇESFÖ scores and CPRS anxiety subscale scores (r = 0.300, p = 0.001), and also Rosenberg self-esteem scale scores (r = 0.470, p < 0.001). Conclusion Children and adolescents with ADHD who had comorbid SAD may differ from ADHD patients without SAD in terms of ADHD subtype, clinical features and self-esteem.

Characterizing the time course of automatic action tendencies to affective facial expressions and its dysregulation in social anxiety disorder

Affective facial expressions elicit automatic approach or avoidance action tendencies, which are dysregulated in Social Anxiety Disorder (SAD). However, research has not dissociated the initiation and execution phases of automatic action tendencies, which may be distinctly modulated by affective faces and SAD. In Study 1, fifty adults completed a modified Approach-Avoidance Task (AAT) that characterized the time course of automatic approach or avoidance actions elicited by affective faces. In the initiation phase, happy faces elicited greater automatic approach tendencies compared to angry faces, an effect that linearly weakened across the execution phase. In Study 2, 44 adults with a principal diagnosis of SAD and 22 healthy comparison (HC) adults completed a similar AAT. Compared to the HC group, the SAD group exhibited an inconsistent time course of automatic action tendencies to neutral faces. Specifically, SAD was characterized by relatively weak initiation of automatic approach tendencies, but relatively stronger execution of automatic approach tendencies. In contrast, the HC group exhibited relatively similar initiation and execution of automatic approach tendencies to neutral faces. Together, these results demonstrate that the initiation and execution of automatic action tendencies are differentially modulated by affective faces and SAD.

Hemogram parameters in childhood anxiety disorders: Could anxiety disorders be related with inflammation?

In the etiology of anxiety disorders, immune system and inflammation are suggested to play a role. This study hypothesized that there is a relationship between anxiety disorders and inflammation. This retrospective study included 131 children and adolescents between the ages 6–17 who were diagnosed with anxiety disorders. Control group consisted of 131 healthy children with no history of psychiatric disorders or chronic inflammatory conditions. White blood cell (WBC), neutrophil (NEU), lymphocyte, monocyte, basophil, eosinophil values and other hematological markers were noted. From those values, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and other ratios were calculated. WBC and NEU values were significantly higher in children and adolescents with anxiety disorder compared to the control group. In addition, NLR, MLR and PLR values were significantly higher than the control group. Other measured parameters and calculated values did not differ between study groups. No statistically significant difference was found between Generalized Anxiety Disorder (GAD) group, Social Anxiety Disorder group and Not Otherwise Specified Anxiety Disorders (AD-NOS) group in terms of hematological markers except RDW-CV. Only RDW-CV was found statistically significantly higher in AD-NOS group compared to GAD. These results show that there is an association between inflammation and anxiety disorders. Also, it is postulated that hematological parameters can be used as a useful marker in the follow-up of patients with anxiety disorders.

Neuropsychological Comparison Between Patients with Social Anxiety and Healthy Controls: Weak Central Coherence and Visual Scanning Deficit.

IntroductionAlthough deficits in neuropsychological functioning have been reported in social anxiety disorder (SAD), studies focusing on neuropsychological dysfunction in SAD are limited, and the evidence is still lacking. The purpose of this study was to examine the deficits in neuropsychological functioning in patients with SAD by comparing SAD patients and a healthy control (HC) group.Materials and MethodsA total of 72 participants (20 in the SAD group and 52 in the HC group) were assessed with neuropsychological tests, consisting of the Rey Complex Figure Test (RCFT) to measure central coherence and the Trail Making Test A and B (TMT-A; TMT-B) to measure visual scanning and executive functioning.ResultsAnalysis of covariance with depressive symptoms as a covariate revealed that central coherence (RCFT) and visual scanning (TMT-A) were significantly lower in the SAD group than in the HC group. No difference was found in executive functioning (TMT-B) when the effect of visual scanning was considered.DiscussionOur findings suggest that SAD patients have weak central coherence and deficits in visual scanning compared to healthy controls. The clinical implications of these neuropsychological functioning deficits in SAD patients are discussed.

Off-task thinking among adults with and without social anxiety disorder: an ecological momentary assessment study

ABSTRACT Although task-unrelated thinking (often conceptualised as “mind-wandering”) has been increasingly investigated in recent years, the content and correlates of everyday off-task thought in clinical disorders, particularly anxiety disorders, remain poorly understood. We aimed to address this gap by using ecological momentary assessment to assess off-task and on-task thoughts in adults with social anxiety disorder (SAD) and demographically matched controls. Findings showed that individuals with SAD more frequently engaged in internally oriented off-task thinking than healthy controls, but not externally oriented off-task thinking. Compared to thoughts focused on the task at hand, adults with SAD rated their internal off-task thoughts as less controllable, more self-focused, and as associated with worse mood than controls. However, when the SAD group was focused on the task at hand, group differences disappeared. Daily findings were paralleled by higher scores in SAD on a trait measure of unintentional, but not intentional, mind-wandering. In sum, the content and mood correlate of internally oriented off-task thoughts depended on the presence of clinical anxiety. In addition, focusing on the task at hand normalised thought content and mood in SAD, highlighting a window for intervention.

Reduced left visual field bias for faces in adolescents with social anxiety disorder

ABSTRACT Introduction: Individuals tend to explore the left side of a face first and for a longer time in comparison to the right side. This left visual field (LVF) bias is suggested to reflect right hemispheric dominance for face processing. Social anxiety disorder (SAD) is associated with maladaptive interpretations of facial expressions, but it is not known whether this is linked to an atypical LVF bias. Previous studies have reported a reduced LVF bias in autism, a condition overlapping with SAD. This pre-registered study examined the LVF bias in adolescents with SAD. Methods: Eye-tracking was used to investigate the ratio of first fixations to the left on upright and inverted face stimuli in 26 adolescents (13-17 years) with SAD and 23 healthy controls primed to look either between the eyes or at the mouth. Results: The SAD group showed a smaller LVF bias and an atypical face inversion effect when primed to look at the eyes. Autistic traits predicted a smaller LVF bias, independently of social anxiety level. Conclusions: Results suggest that SAD is associated with impaired processing of faces at an early stage of visual scanning. The findings contribute to a better understanding of SAD and its overlap with autism.

Diagnostic and dimensional evaluation of implicit reward learning in social anxiety disorder and major depression.

Increasing evidence supports the presence of an anhedonic endophenotype in major depressive disorder (MDD), characterized by impairments in various components of reward processing, particularly incentive motivation, effort-based decision making, and reward learning. In addition to its prominent role in MDD, reward processing dysregulation has been proposed as a transdiagnostic risk and/or maintenance factor for a range of other forms of psychopathology. Individuals with social anxiety disorder (SAD)-a condition that frequently co-occurs with MDD-demonstrate low trait positive affectivity and altered processing of rewards and positively valenced information. However, no studies to date have directly tested reward learning-the ability to modulate behavior in response to rewards-in this population. The current study evaluated reward learning in MDD, SAD, and healthy control subjects (N = 90) using a well-validated signal detection task. Given increasing data supporting transdiagnostic features of psychopathology, we also evaluated associations between anhedonia and task performance transdiagnostically in the patient sample. Contrary to expectations, results indicated no significant group differences in response bias in the full sample, suggesting no diagnostic differences in reward learning. However, dimensional analyses revealed that higher self-reported anhedonia (but not general distress or anxious arousal) was associated with worse reward learning in both the MDD and SAD groups explaining about 11% of the variance. Deficits in implicit reward learning are associated with anhedonia but not necessarily with major depressive disorder as a diagnosis, which supports the use of transdiagnostic approaches to understanding psychopathology.

Abnormal asymmetry of thalamic volume moderates stress from parents and anxiety symptoms in children and adolescents with social anxiety disorder

Social anxiety disorder (SAD) usually onsets in childhood or adolescence and is associated with brain development and chronic family stress during this period. As an information hub, the thalamus plays a crucial role in the development of emotion processing and stress regulation. Its structural and functional lateralization have been related to mental disorders. This study examined the age-dependent asymmetry of the thalamic volume in children and adolescents with SAD. We further examined the role of the thalamic asymmetry in moderating the relationships between parental alienation, which is a main source of familial stress for children and adolescents, and anxiety symptoms in this population. Fifty-three medication-free children and adolescents with SAD and 53 typical developing controls (age: 8–17) were included. Anxiety severity was measured using the Screen for Child Anxiety-Related Emotional Disorders (SCARED). We estimated the bilateral thalamic volume and examined diagnosis effect and age-group difference on the thalamic asymmetry. We further examined the moderation of the thalamic asymmetry on the associations between scores on the parental alienation, social phobia, and total SCARED. Compared with controls, the SAD group exhibited significantly abnormal asymmetry in thalamic volume. This asymmetry became more evident in the older age group. Furthermore, this asymmetry significantly weakened the relationships between parental attachment and total SCARED score. The asymmetry of the thalamic volume and its age-group difference provide novel evidence to support brain developmental abnormalities in children and adolescents with SAD. The findings further revealed interactions between physiological and chronic stress in children and adolescents with SAD.This article is part of the special issue on ‘Stress, Addiction and Plasticity’.

Social trauma and its association with posttraumatic stress disorder and social anxiety disorder

The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.

Association of theory of mind and empathy abilities in adolescents with social anxiety disorder

Studies have shown that elevated empathic abilities and impaired theory of mind (ToM) tasks may be associated with social anxiety disorder (SAD). Adolescence is a critical period for the onset of SAD which may cause impairment in various domains of functioning. We aimed to investigate the association of ToM and empathy characteristics in adolescents diagnosed as having SAD. Forty-one drug-naive adolescents (between 12 and 18 years), who were diagnosed as having SAD without comorbidities were enrolled in the patient group. Forty adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The sample was evaluated via the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The severity of the SAD symptoms was evaluated using the Social Anxiety Scale for Adolescents. ToM was evaluated with the Reading the Mind in the Eyes Test and emotion recognition was assessed by Faces Test. The KA-SI Empathic Tendency Scale was used to assess empathic abilities. The average age was 14.36 ± 1.41 years in the SAD group and 14.30 ± 1.04 years in the control group. Twenty-eight adolescents were female in the SAD and control groups. SAD and healthy controls did not differ in terms of sociodemographic data. There were higher scores in the KA-SI cognitive and affective empathic subscales (p < .001 in all scales) in the SAD group compared with the healthy controls. Adolescents with SAD have more difficulties both in Reading the Mind in the Eyes Test and Faces Test. The results of this study may indicate that although adolescents with SAD may be impaired in decoding aspects of ToM they may evaluate themselves as more empathic in self-report tests. The discrepancy between objective tests of ToM decoding and subjective reports of empathy may play an important role in the etiology and treatment of SAD in adolescents.

Measuring Biases of Visual Attention: A Comparison of Four Tasks.

Attention biases to stimuli with emotional content may play a role in the development and maintenance of anxiety disorders. The most commonly used tasks in measuring and treating such biases, the dot-probe and spatial cueing tasks, have yielded mixed results, however. We assessed the sensitivity of four visual attention tasks (dot-probe, spatial cueing, visual search with irrelevant distractor and attentional blink tasks) to differences in attentional processing between threatening and neutral faces in 33 outpatients with a primary diagnosis of social anxiety disorder (SAD) and 26 healthy controls. The dot-probe and cueing tasks revealed no differential processing of neutral and threatening faces between the SAD and control groups. The irrelevant distractor task showed some sensitivity to differential processing for the SAD group, but the attentional blink task was uniquely sensitive to such differences in both groups, and revealed processing differences between the SAD and control groups. The attentional blink task also revealed interesting temporal dynamics of attentional processing of emotional stimuli and may provide a uniquely nuanced picture of attentional response to emotional stimuli. Our results therefore suggest that the attentional blink task is more suitable for measuring preferential attending to emotional stimuli and treating dysfunctional attention patterns than the more commonly used dot-probe and cueing tasks.

The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder.

The aim of our study is to compare the attachment characteristics and the theory of mind abilities measured by the Eyes Test between social anxiety disorder (SAD) patients and healthy controls. Another aim of our study is to investigate the relationship between attachment characteristics, theory of mind abilities and disease severity in patients with SAD. 47 consecutive patients with SAD and 50 healthy controls were recruited for the study. Sociodemographic data form, SCID-I Structured Clinical Interview form Patient Version, Beck Depression Inventory (BDI), Reading Mind in the Eyes Test (Eye Test), Liebowitz Social Anxiety Scale (LSAS), Experiences in Close Relationship Inventory (ECR) and State-Trait Anxiety Inventory (STAI) were administered to all participants. The BDI, LSAS anxiety and avoidence, ECR and anxiety and avoidance, STAI state and trait anxiety scores of the SAD group were higher than the controls, but the Eyes Test scores were lower. It was observed that the Eyes Test score difference between the two groups survived when controlled for BDI and STAI state and trait anxiety scores. In the SAD group, both ECR anxiety and avoidance scores were associated with LSAS anxiety and avoidance scores. Eyes Test scores were associated with LSAS anxiety and avoidance scores. In regression analysis, it was observed that the Eyes Test, ECR anxiety and avoidance scores effected both the LSAS anxiety and the LSAS avoidance scores. In SAD patients, the theory of mind functions was impaired when compared to healthy controls, and this difference has been found to be independent of anxiety or depression levels. Attachment anxiety and avoidance dimensions have negative effects on SAD disease severity. The fact that the theory of mind ability is inversely related with SAD severity suggests that interventions to improve social cognition might have a potential to decrease the severity of disease in SAD.

The Role of Traumatic Experiences and Posttraumatic Stress on Social Anxiety in a Youth Sample in Lithuania.

Emerging adulthood is a developmental stage with an increased vulnerability to mental disorders. Social anxiety disorder (SAD) is highly prevalent anxiety disorder especially among adolescents and young adults. Furthermore, SAD is highly comorbid with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the prevalence of SAD, life-time traumatic experiences and PTSD among Lithuanian young adults studying at the Universities. We also aimed to search for associations between social anxiety, traumatic experiences, and posttraumatic stress in our sample. In total 590 young adults (67.7% female), aged 20years on average and studying at the Universities in Lithuania were recruited for this study. Self-report measures were used to measure SAD and PTSD. SAD was measured using the Social Phobia Inventory (SPIN), and PTSD was measured using the Impact of Event Scale - Revised (IES-R). SAD prevalence based on SPIN cut-off >26 in our sample was 15.3%, life-time trauma exposure was 67.5%. No association between accumulative trauma exposure and SAD was found. SAD symptoms were highly correlated with PTSD symptoms. Comorbidity between SAD and PTSD was high, with 32.2% cases of PTSD in SAD group. We found high comorbidity between SAD and PTSD in our study among young adults. Further studies are needed to explore development of SAD and PTSD in longitudinal studies.

Visual attention to emotional faces in adolescents with social anxiety disorder receiving cognitive behavioral therapy.

Social anxiety disorder (SAD) is a psychiatric condition that often onsets in childhood. Cognitive models underline the role of attention in the maintenance of SAD, but studies on youth populations are few, particularly those using eye tracking to measure attention. Cognitive behavioral therapy (CBT) for SAD includes interventions targeting attention, like exposure to eye contact, but the link between CBT and attention bias is largely unexplored. This study investigated attention bias in youth with SAD and the association with outcome from CBT. Latency to attend to pictures of faces with different emotions (vigilance) and latency to disengage from social stimuli (avoidance) was examined in N = 25 adolescents (aged 13-17) with SAD in relation to treatment outcome. Vigilance was operationalized as the time it took to relocate the gaze from a central position to a peripherally appearing social stimulus. The latency to disengage from a centrally located social stimulus, when a non-social stimulus appeared in the periphery, was used as a proxy for avoidance. Attention characteristics in the SAD group were compared to non-anxious (NA) controls (N = 22). Visual attention was measured using eye tracking. Participants in both the SAD and NA groups were vigilant towards angry faces, compared to neutral and happy faces. Similarly, both groups disengaged attention faster from angry faces. Adolescents with SAD who disengaged faster from social stimuli had less social anxiety after CBT. The results indicate that anxious youth display a vigilant-avoidant attention pattern to threat. However, partly inconsistent with previous research, the same pattern was observed in the NA group.

The Impact of Negative Emotions on Drinking Among Individuals with Social Anxiety Disorder in Daily Life: The Moderating Effect of Maladaptive Emotion Regulation Strategies

Emerging evidence suggests that increased negative emotions and maladaptive emotion regulation (ER) strategies underlie social anxiety disorder (SAD) and alcohol related problems, but little is known about how specific negative emotions and maladaptive ER strategies interact with one another in predicting drinking in daily life. This study aimed to investigate (1) the impact of within-person level negative emotions and maladaptive ER strategies on drinking among individuals with SAD, and (2) the moderating effect of specific maladaptive ER strategies (avoidance, rumination, suppression) on the relationship between negative emotions and alcohol craving in daily life via an ecological momentary assessment (EMA). Results revealed that the SAD group (n = 66) showed a higher increase rate in alcohol craving when they were socially anxious, tense and lonely than the non-SAD group (n = 53). In moderation analyses, maladaptive ER strategies interacted with negative emotions in predicting alcohol craving and different patterns were observed between groups: rumination was a significant moderator for the SAD group, while avoidance was for the non-SAD group in both concurrent and lagged effect analyses. Implications for the future research and interventions on daily negative emotions and maladaptive ER strategies are discussed.

Intrinsic functional connectivity in social anxiety disorder with and without comorbid attention deficit hyperactivity disorder

Neuroimaging research about social anxiety disorder (SAD) points to hyperactivity in the fear circuit and altered connectivity between the fear circuit and the intrinsic connectivity networks that modulate it. We investigated intrinsic functional connectivity changes in SAD patients by taking into consideration the commonly overlooked comorbidity of attention deficit hyperactivity disorder (ADHD). We compared intrinsic functional connectivity alterations in 16 patients with pure SAD, 18 patients with SAD and comorbid ADHD and 21 healthy controls using seed-to-voxel functional connectivity analyses. Hypoconnectivity of the right fusiform gyrus with the left lingual gyrus was the unique difference between whole SAD group and healthy controls, while in the pure SAD group the fusiform gyrus displayed hypoconnectivity with the posterior default mode network (DMN) regions. In contrast, ADHD comorbidity was associated with hyperconnectivities of the salience network (SN) with the fusiform cortex and the posterior DMN regions, and hyperconnectivities of the posterior DMN with visual, somatosensory and motor cortices. The dichotomic dissociation of the SAD related functional connectivity changes into hypoconnectivities in the pure SAD group vs hyperconnectivities in the SAD-ADHD group leads also to the question, whether ADHD treatment can be considered an alternative for selected SAD cases.

Repeated stress leads to enhanced cortisol stress response in child social anxiety disorder but this effect can be prevented with CBT

Social anxiety disorder (SAD) is associated with continual social stress in everyday life. Two physiological components of stress are the hypothalamus–pituitary–adrenal axis, as captured by cortisol reactivity, and the autonomous nervous system, as captured by salivary alpha amylase (sAA) reactivity. In children with SAD, initial evidence points to dysregulated physiological stress reactivity for both systems. Furthermore, hardly any studies have assessed stress reactivity twice, including exploring possible changes after cognitive behavioral therapy (CBT). Children with SAD (n = 65; aged 9–13 years) and healthy controls (HCs, n = 55) participated in a social stress task (Trier Social Stress Test for Children, TSST-C), which was repeated with children with SAD after either 12 sessions of CBT or a waiting period to explore possible habituation or sensitization effects. Before treatment, children in the SAD and HC groups did not differ in their cortisol stress reactivity toward the TSST-C but did differ in their sAA response with a more pronounced response in the SAD group. After treatment, children with SAD in the waitlist group differed from children with SAD in the CBT group by showing stronger cortisol reactivity and a higher responder rate, indicative of a possible sensitization to stress. No difference was found for sAA. Future research should compare children with SAD and HC children concerning the effect of repeated stress on sensitization.

Pupil dilation to emotional expressions in adolescent social anxiety disorder is related to treatment outcome

Atypical attention to potential social threats, such as emotional faces, may be one of the core mechanisms underlying social anxiety disorder (SAD). Pupil dilation is an index of locus coreuleus-noradrenergic activity, and closely linked to attention. In the present study, pupil dilation was studied in adolescents with SAD (N = 26; 22 Female) before the onset of a 12-week cognitive behavioral treatment, and in healthy controls (N = 23). Stimuli were faces with angry or happy emotional expressions. Contrary to our hypothesis, the SAD group did not show hyper-responsiveness to angry compared to happy faces. Instead, an atypical time course of the pupil dilation response was found, resulting in an attenuated response during late time stages. Larger pupil dilation amplitude to happy faces before treatment was related to worse treatment response. These results contribute significantly to our understanding of the mechanisms underlying adolescent SAD.

Analysis on components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorders

Objective To analyze the components of attentional bias on anger and disgust emotional faces in college students with social anxiety disorder. Methods DSM-V was used for clinical diagnosis after the initial screening with Interaction Anxiousness Scale. The subjects meet the inclusion criteria were divided into social anxiety disorder group (SAD group) and healthy control group (HC group). Koster's improved dot-probe paradigm was used in a 2 (group: SAD group, HC group)×2 (emotion categories: anger, disgust) mixed-design experiment, and the different characteristics of attentional bias between the two groups on different emotional faces were compared. Results In SAD group, under the condition of angry faces, the response times to the probe targets with the same or different positions from the negative faces were (369.7±53.0)ms and (447.2±54.3)ms, while the response times were (429.6±70.2)ms and (444.2±55.8)ms under the condition of disgust faces, and the SAD group showed attentional bias towards both anger and disgust faces (t=24.15 and 2.45, P<0.05). Under the condition of anger faces, the response time of HC group to the consistent and inconsistent position of probe target were (466.9±40.0)ms and (483.8±43.8) ms, and the HC group had an attentional bias towards anger faces(t=6.58, P<0.05). The response time under disgust faces was (493.8±43.6)ms and (498.0±46.7)ms in HC group, and did not show an attentional bias towards disgust(t=1.65, P=0.108). The scores of attentional orientation to anger faces in SAD group were significantly higher than those in the HC group(F=19.26, P<0.001), but there was no significant difference between the two groups towards disgust faces(F=0.02, P=0.897). Compared with disgust faces, the attentional orientation to anger faces was faster in both HC and SAD groups (F=101.66 and 8.00, P<0.05). Compared with the HC group, the SAD group had an impaired attentional disengagement from anger faces(F=8.66, P=0.004). Conclusion The students with social anxiety disorder have attentional bias towards both anger and disgust facial expressions, which manifested as facilitated attentional orientation and impaired attentional disengagement to anger faces. Key words: Social anxiety disorder; College students; Attentional bias; Facilitated attentional orientation; Impaired attentional disengagement

Facial Affect and Interpersonal Affiliation: Displays of Emotion During Relationship Formation in Social Anxiety Disorder.

Social anxiety disorder (SAD) often involves difficulty developing relationships. Facial expressions are important in relationship formation, but data are limited regarding facial display production among persons with SAD during social interaction. The current study compared facial displays of individuals diagnosed with SAD (n=41) to control participants (n=24) as they interacted with a confederate; confederates and observers then rated their desire for future interaction with participants. Automated software used the Facial Action Coding System (FACS; Ekman & Friesen, 1978) to classify displays. During portions of the interaction that involved listening to partners, the SAD group smiled less frequently and less intensely than controls, and lower smiling was associated with others' lower desire for future interaction with participants. Diminished positive facial affect in response to interaction partners may disrupt relationship formation in SAD and may serve as an effective treatment target.