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Fearful Imagery in Social Phobia: Generalization, Comorbidity, and Physiological Reactivity
Open accessAbstract
Background Social phobia has been characterized as a disorder of exaggerated fear of social threat and heightened sensitivity to imagery of social failure.Methods To assess the physiological basis of this description, social phobia patients (n=75) and demographically matched control participants (n=75) imagined neutral and fearful events while acoustic startle probes were occasionally presented and eye-blink responses (orbicularis occuli) recorded. Changes in heart rate, skin conductance level, and facial expressivity were also indexed. In addition to comparing control participants and social phobia patients, the influences of diagnostic subtype (circumscribed, generalized), comorbid depression, and chronicity were assessed.Results Patients exceeded control participants in startle reflex and autonomic responding during imagery of social threat, whereas the groups evinced commensurate reactivity to contents depicting commonly shared fears (survival threat). Individuals with circumscribed performance phobia were similar to control participants, with the exception of more robust reactions to idiographic, performance fear imagery. In contrast, generalized phobic patients were characterized by longer disorder chronicity and demonstrated heightened sensitivity to a broader range of fear contents. Those with generalized phobia plus comorbid depression showed attenuation of fear-potentiated startle and reported the most protracted social anxiety.Conclusions Subtypes of social phobia can be objectively distinguished in patterns of physiological reactivity. Furthermore, subtypes vary systematically in chronicity and defensive engagement with the shortest disorder duration (circumscribed phobia) associated with the most robust and focal physiological reactivity, followed by broader defensive sensitivity in more chronic generalized phobia, and finally attenuation of the formerly exaggerated fear potentiation in the comorbidly depressed, the most chronic form.
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“Social phobics with circumscribed fear restricted to performance contexts exhibit defensive responses similar to those of simple phobics, in which they show elevated fear of their personal fears but not of standard fears (McTeague et al, 2009).”
From Phasic vs Sustained Fear in Rats and Humans: Role of the Extended Amygdala in Fear vs Anxiety (2010) · cites this paper as McTeague et al, 2009
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“In contrast, individuals with generalized social phobia show a range of elevated fear that extends beyond their personal fears to more generally shared fears (McTeague et al, 2009).”
From Phasic vs Sustained Fear in Rats and Humans: Role of the Extended Amygdala in Fear vs Anxiety (2010) · cites this paper as McTeague et al, 2009
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Phasic vs Sustained Fear in Rats and Humans: Role of the Extended Amygdala in Fear vs Anxiety
Davis, M., Walker, D. L., Miles, L., & Grillon, C. (2010) · Neuropsychopharmacology · doi:10.1038/npp.2009.109 · Cited by 1,513
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Self-citationA Cognitive Behavioral Model of Social Anxiety Disorder
Heimberg, R. G., Brozovich, F. A., & Rapee, R. M. (2010) · Social Anxiety · doi:10.1016/b978-0-12-375096-9.00015-8 · Cited by 407
Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis
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McTeague, L. M., Lang, P. J., Laplante, M.-C., Cuthbert, B. N., Shumen, J. R., & Bradley, M. M. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.08.023 · Cited by 250
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Metadata
- Authors
- McTeague, L. M., Lang, P. J., Laplante, M.-C., Cuthbert, B. N., Strauss, C. C., & Bradley, M. M.
- Affiliations
- University of Florida (US)
- University of Minnesota (US)
- Corresponding author
- Lang, Peter J.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2009-03
- Volume
- 65
- Issue
- 5
- Pages
- 374-382
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC2735121
- OpenAlex
- W2070583390
- Cited by
- 169
- References
- 60
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 6 · 2021: 11 · 2020: 3 · 2019: 4 · 2018: 8 · 2017: 9 · 2016: 13 · 2015: 14 · 2014: 19 · 2013: 17 · 2012: 12
- FWCI
- 14.78
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (P50MH052384, P50MH072850, F31MH069048)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- social anxiety disorder, fear potentiation, acoustic startle response, autonomic reactivity, skin conductance, heart rate, facial expressivity, generalized social phobia, comorbid depression, fear generalization, survival threat, social anxiety
- MeSH terms
- Adult, Depression, Fear, Female, Galvanic Skin Response, Heart Rate, Humans, Imagination, Male, Phobic Disorders, Psychiatric Status Rating Scales, Severity of Illness Index, Reflex, Startle, Case-Control Studies, Age of Onset
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