Neural Bases of Social Anxiety Disorder: Emotional Reactivity and Cognitive Regulation During Social and Physical Threat
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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 cognitive-linguistic regulation of emotional reactivity induced by social (harsh facial expressions) and physical (violent scenes) threat while undergoing functional magnetic 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 greater emotion-related neural responses in patients than controls, with social anxiety symptom severity related to activity in a network of emotion- and attention-processing regions in patients only. Viewing physical threat produced no between-group differences. Regulation during social threat resulted in greater cognitive and attention 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 interventions for social anxiety disorder.
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Functional connectivity studies report disrupted amygdala-prefrontal communication in SAD during rest, implicit emotion regulation, and explicit emotion regulation tasks.
“Functional connectivity studies have found that compared to healthy individuals, individuals with SAD demonstrate disrupted communication between the amygdala and prefrontal regions during resting state (vmPFC (Hahn et al., 2011)), as well as during implicit (vmPFC (Young et al., 2017)) and explicit emotion regulation tasks (dl/vlPFC (Goldin et al., 2009)).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin et al., 2009
Goldin et al.’s Results and Discussion on emotion regulation report that healthy controls showed greater dorsolateral PFC activity than participants with SAD while regulating social threat. That supports a group difference during an explicit regulation task, but the reported BOLD activity does not establish disrupted functional connectivity or communication between the amygdala and prefrontal regions. The resting-state and implicit-task portions of the sentence are attributed to other citations, not Goldin et al. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGreater dmPFC activation and amygdala connectivity correspond to reappraisal success in healthy people and in SAD patients.
“Further, greater dmPFC activation and connectivity with the amygdala corresponded to reappraisal success in both healthy individuals (Banks, Eddy, Angstadt, Nathan, & Phan, 2007; Wager, Davidson, Hughes, Lindquist, & Ochsner, 2008) and patients with social anxiety disorder (Goldin et al., 2009).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin et al., 2009
The Results > Emotion Regulation section reports that greater dorsomedial PFC activity during cognitive regulation was associated with reduced negative-emotion ratings in both SAD patients and healthy controls. It does not report that connectivity with the amygdala corresponded to regulation success. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPeople with social phobia report stronger negative affect while looking at negative pictures from the IAPS.
“In terms of emotional reactivity, individuals with social phobia report more negative affect when viewing negative images from the international affective picture system (Goldin, Manber, Hakimi, Canli, & Gross, 2009)”
From Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia (2013) · cites this paper as Goldin, Manber, Hakimi, Canli, & Gross, 2009
The Results (Emotional Reactivity, page not provided) report higher negative-emotion ratings in the social anxiety disorder group than in healthy controls while viewing the study’s images. But the Methods (Stimuli, page not provided) describe actor-produced faces and violent scenes collected from internet sites, not images from the International Affective Picture System. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSeveral models of SAD emphasize the role of difficulties in emotion regulation, mainly decreased emotional awareness, emotional hyper-reactivity, and difficulty regulating the emotional experience.
“Several models of SAD emphasize the role of difficulties in ER, mainly decreased emotional awareness, emotional hyper-reactivity, and difficulty regulating the emotional experience (Clark and Wells, 1995; Rapee and Heimberg, 1997; Clark and McManus, 2002; Goldin et al., 2009).”
From Can dialectical behavior therapy skills group treat social anxiety disorder? A brief integrative review (2024) · cites this paper as Goldin et al., 2009
The “Emotional Reactivity and Regulation in SAD” section says SAD models highlight emotional hyper-reactivity and describes failure of emotion regulation as a key feature. It does not identify decreased emotional awareness as one of those difficulties; searches for that phrase and for awareness of emotions found no supporting passage. Page numbers were not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHigher affective reactivity is described in people with anxiety disorders, particularly social anxiety disorder, where patients also display hyper-reactivity within similar brain regions.
“Higher affective reactivity is described in people with anxiety disorders, particularly social anxiety disorder, where patients also display hyper-reactivity within similar brain regions (Goldin et al., 2009).”
From Neuroimaging and psychophysiological investigation of the link between anxiety, enhanced affective reactivity and interoception in people with joint hypermobility (2014) · cites this paper as Goldin et al., 2009
The Discussion’s Emotional Reactivity section reports greater negative emotion in patients with social anxiety disorder than in controls during both social and physical threat, and greater neural responses in emotion-related regions during social threat. It reports no between-group neural difference for physical threat. The study does not establish that these findings apply to anxiety disorders generally. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Prior findings disagree about which prefrontal subregions are involved and whether activation is increased or decreased relative to healthy controls.
“However, findings have been inconsistent regarding the specific prefrontal sub-regions as well as direction of effects (both relatively increased (Brühl, Delsignore, et al., 2014; Goldin et al., 2009) or decreased activation (Zilverstand et al., 2017) compared to healthy individuals).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin et al., 2009
Amygdala hyper-reactivity to social or emotional cues is consistently linked to SAD pathophysiology, and its degree tracks symptom severity.
“In response to social or emotional stimuli, amygdala hyper-reactivity has been consistently implicated in the pathophysiology of SAD (Davies et al., 2017), the degree of which also corresponds with symptom severity (Goldin, Manber, Hakimi, Canli, & Gross, 2009).”
From Changes in functional connectivity with cognitive behavioral therapy for social anxiety disorder predict outcomes at follow-up (2020) · cites this paper as Goldin, Manber, Hakimi, Canli, & Gross, 2009
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Trait and Daily Emotion Regulation in Social Anxiety Disorder
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COMT Haplotypes Modulate Associations of Antenatal Maternal Anxiety and Neonatal Cortical Morphology
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“This may have important implications for psychiatric disorders associated with alterations in social behaviors and reactions to social threat, as many psychiatric disorders are characterized by alterations in social approach–avoidance systems (Cacioppo et al., 2007; Goldin et al., 2009; Schaefer et al., 2006).”
BackgroundAltered fusiform connectivity during processing of fearful faces in social anxiety disorder
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“Thus, in a study exploring emotion regulation in social anxiety disorder (SAD), subjects with SAD engaged cognitive control regions (DLPFC, dACC) to a larger degree than controls when exposed to physical threat stimuli but to lesser degree during regulation of responses to social threat stimuli (the latter being most…”
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“…to social or emotional cues (Birbaumer et al., 1998; Cooney et al., 2006; Evans et al., 2008; Phan et al., 2006; Stein et al., 2002), the extent of which has been shown to correlate with symptom severity (Cooney et al., 2006; Goldin et al., 2009b; Phan et al., 2006; Shah and Angstadt, 2009).”
BackgroundCortical thickness alterations in social anxiety disorder
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“While neuroimaging studies in SA revealed predominantly increased cerebral activation to facial [11–15] and vocal [16] expressions signaling social threat in the limbic system [12–15], as well as increased activation of secondary visual cortices [12,15], the mediofrontal cortex [11,12,14] and the orbitofrontal cortex…”
BackgroundEmotion Regulation in Social Anxiety Disorder
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“However, fi ndings have been inconsistent regarding the speci fi c prefrontal sub-regions as well as direction of e ff ects (both relatively increased (Brühl, Delsignore, et al., 2014; Goldin et al., 2009) or decreased activation (Zilverstand et al., 2017) compared to healthy individuals).”
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Can fMRI be used to predict the course of treatment for social anxiety disorder?
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“Several models of SAD emphasize the role of difficulties in ER, mainly decreased emotional awareness, emotional hyper-reactivity, and difficulty regulating the emotional experience (Clark and Wells, 1995; Rapee and Heimberg, 1997; Clark and McManus, 2002; Goldin et al., 2009).”
Background
- Authors
- Goldin, P. R., Manber, T., Hakimi, S., Canli, T., & Gross, J. J.
- Affiliations
- Stanford University (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2009-02-01
- Volume
- 66
- Issue
- 2
- Pages
- 170
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC4142809
- OpenAlex
- W2151490465
- Cited by
- 486
- References
- 78
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 26 · 2023: 13 · 2022: 15 · 2021: 27 · 2020: 19 · 2019: 19 · 2018: 38 · 2017: 26 · 2016: 34 · 2015: 40 · 2014: 52 · 2013: 43 · 2012: 37
- FWCI
- 41.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- National Institute of Mental Health (R01MH058147, MH 58147)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- social anxiety disorder, cognitive emotion regulation, social danger, physical threats, negative emotions, cognitive control, dorsolateral prefrontal cortex, attentional control, neural markers, facial expressions
- MeSH terms
- Adult, Amygdala, Arousal, Attention, Awareness, Brain Mapping, Cerebral Cortex, Cognition, Dominance, Cerebral, Female, Humans, Internal-External Control, Limbic System, Magnetic Resonance Imaging, Male, Nerve Net, Oxygen, Phobic Disorders, Young Adult
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