Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The extrastriate body area processes body stimuli and probably also processes body-related self versus other stimuli.

“In addition, the extrastriate body area (EBA), a brain region involved in processing of body stimuli, is likely involved in processing self- vs. other-referential body stimuli (Vocks et al., 2010).”

• cites Vocks et al., 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The fusiform gyrus is involved in face processing more broadly.

“The fusiform gyrus, an area involved in face processing more broadly (which is related to the sensory processing of the first step in the model described above, Kanwisher et al., 1997)”

• cites Kanwisher et al., 1997 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The neural circuitry for detecting threat underlying fears of negative evaluation includes the amygdala, precuneus, insula, anterior cingulate, and prefrontal cortices.

“The threat-detection neural circuitry underlying fears of negative evaluation involves the amygdala, precuneus, insula, anterior cingulate, and prefrontal cortices (Brühl et al, 2014; Etkin and Wager, 2007).”

• cites Brühl et al, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Etkin and Wager, 2007 sourcePartly supported

  The Results (Common Mechanisms for Anxiety Disorders and Normal Fear; page unavailable) identify amygdala and insula hyperactivity in social anxiety disorder, supporting part of the claimed circuitry. They report precuneus hyperactivity in PTSD, not social anxiety disorder; the Abstract Results likewise associate anterior cingulate and ventromedial prefrontal hypoactivation specifically with PTSD. The paper does not establish this full set of regions as threat-detection circuitry underlying fear of negative evaluation. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Three additional studies have examined other implicit or explicit emotion regulation strategies in response to SAD treatment, including internet-delivered CBT and CBT.

“Three additional studies have explored other implicit (Burklund et al., 2015) or explicit emotion regulation strategies in response to treatment for SAD, including internet delivered CBT (Månsson et al., 2013), and CBT (Goldin et al., 2013, 2014).”

• cites Burklund et al., 2015 sourcePartly supported

  The Introduction identifies affect labeling as an implicit emotion-regulation strategy, and the Procedures describe testing it in participants with social phobia. But the paper compares participants during a single fMRI session; it does not examine how the strategy changes in response to SAD treatment. The Discussion only proposes a possible connection to cognitive behavioral therapy. No page numbers are available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Månsson et al., 2013 sourceNot checked — no full text of the source
• cites Goldin et al., 2013, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Prior research found that emotionally evocative stimuli were associated with enhanced activation in the fusiform face area in individuals with social anxiety disorder.

“prior research in which emotionally evocative stimuli were associated with enhanced activation in the fusiform face area in individuals with social anxiety disorder (Frick et al., 2013).”

• cites Frick et al., 2013 sourcePartly supported

  The Discussion reports heightened bilateral fusiform gyrus reactivity in people with social anxiety disorder when viewing fearful rather than neutral faces. The Methods say the analysis used an anatomical fusiform gyrus mask; our copy does not identify the activated region specifically as the fusiform face area. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Overactivation of the putamen is associated with anxiety-related distress.

“Overactivation of the putamen is associated with anxiety-related distress (Carlisi et al., 2017), though other studies have reported opposite effects (Etkin and Wager, 2007).”

• cites Carlisi et al., 2017 sourceNot checked — no full text of the source
• cites Etkin and Wager, 2007 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The amygdala and prefrontal cortex regions are implicated in threat encoding, threat detection and fear expression across species and tasks.

“the amygdala and PFC regions are implicated in threat encoding, threat detection and fear expression across species and tasks (LeDoux, 2014).”

• cites LeDoux, 2014 sourcePartly supported

  In “Conditioned Fear as a Circuit Function” (page unavailable), LeDoux describes amygdala circuits learning threat cues and producing defensive responses. “Survival Circuits and Global Organismic States” says threat-response mechanisms can be studied in humans and other animals. The copy does not establish that both the amygdala and PFC perform all three stated functions across tasks; it also distinguishes defensive responses from the conscious feeling of fear. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Positive connectivity between the amygdala and prefrontal cortex is important for emotion regulation.

“A robust body of literature suggests that positive connectivity between the amygdala and prefrontal cortex is important for emotion regulation (Brühl et al., 2014; Etkin and Wager, 2007).”

• cites Brühl et al., 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Etkin and Wager, 2007 sourcePartly supported

  The Discussion section on emotion regulation links prefrontal activity and amygdala decreases to emotional-conflict resolution and fear extinction, supporting a role for their interaction in regulation. It does not establish that *positive connectivity* between them is important; the examples describe decreased amygdala activity and top-down inhibition. Page numbers were not provided in our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The amygdala has a role in threat-responding for social anxiety disorder.

“given its role in threat-responding for social anxiety disorder (Pape and Pare, 2010)”

• cites Pape and Pare, 2010 sourcePartly supported

  The Introduction identifies the amygdala as a key region for processing aversive signals and fear learning in humans, and discusses abnormal fear responses in anxiety disorders. It does not specifically establish the amygdala’s role in threat-responding in social anxiety disorder. No page numbers were provided in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Prior research found differential activation of the fusiform face area during self-observation of a working memory task based on severity of social anxiety symptoms.

“prior research in which differential activation of the fusiform face area was observed during self-observation of a working memory task based on severity of social anxiety symptoms (Pujol et al., 2013).”

• cites Pujol et al., 2013 sourcePartly supported

  The Correlation of brain activation with social anxiety scores section reports greater fusiform gyrus activation in patients with lower-severity social anxiety than in controls. The Experimental task section describes viewing recordings of participants recalling verbal narratives, but does not identify the task as a working-memory task; the reported region is the fusiform gyrus, not specifically the fusiform face area. No page numbers were available in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

In the current sample, mean LSAS severity decreased from pre- to post-treatment in CBT and ACT but not in the waitlist.

“mean LSAS severity scores from pre- to post-treatment were as follows: CBT Pre-treatment: 81.55 (SD = 15.75), Post-treatment: 61.82; (SD = 20.47); ACT Pre-treatment: 90.92 (SD = 21.25), Post-treatment: 66.75 (SD = 19.98), Waitlist Pre-treatment: 69.70 (SD = 22.43), Post-treatment: 69.70 (SD = 15.35).”

May combine two claims.

SAD showed significant differences in both activation and functional connectivity in brain regions tied to self-referential processing.

“Thus, there were significant differences in activation and functional connectivity of brain regions implicated in self-referential processing in SAD.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Activation in the left middle occipital gyrus included an area in the visual cortex that extended into the extrastriate body area.

“Activation in the left middle occipital gyrus included an area in the visual cortex that extended into the EBA.”

May combine two claims.

Across all groups at post-treatment, there was less of a difference in functional connectivity between the right amygdala and vmPFC for Self > Other relative to the difference at pre-treatment, where connectivity was stronger during Other compared to Self.

“Across all groups at post-treatment, there was less of a difference in functional connectivity between the right amygdala and vmPFC for Self > Other relative to the difference at pre-treatment, where connectivity was stronger during Other compared to Self (see Figure 4).”

• Also stated in: § Discussion · plain

  “at post-treatment across all participants (treatment and waitlist), there was enhanced positive connectivity between the right amygdala and the ventromedial prefrontal cortex during self- relative to other-referential processing.”

May combine two claims.

Visual inspection of the direction of effects showed that activation to Self and Other decreased from pre- to post-treatment in the Treatment group, whereas activation to Self and Other increased from pre- to post-treatment in the Waitlist group.

“Visual inspection of the direction of these effects demonstrated that activation to Self and Other decreased from pre- to post-treatment in the Treatment group, whereas activation to Self and Other increased from pre- to post-treatment in the Waitlist group.”

May combine two claims.

Greater reduction in LSAS was associated with stronger connectivity during Self and weaker connectivity during Other at post-treatment, whereas connectivity during Self and Other was comparable at post-treatment for those with less LSAS change.

“LSAS reduction was negatively correlated with change in functional connectivity between the right amygdala and right FFA.”

• Also stated in: § Pre- to post-treatment · plain

  “those with greater reduction in LSAS demonstrated stronger connectivity during Self and weaker connectivity during Other at post-treatment, whereas the strength of connectivity during Self and Other was comparable at post-treatment for those with less LSAS change.”

• Also stated in: § Discussion · plain

  “greater improvement in social anxiety severity from pre- to post-treatment was associated with more positive functional connectivity between the amygdala and fusiform face area in self-referential processing versus other-referential processing compared to individuals who experienced less change in social anxiety severity.”

May combine two claims.

Across all regions, the Treatment group showed greater differential activation to Self > Other at pre-treatment compared to post-treatment, and this pattern was reversed for the Waitlist group.

“Across all regions, the Treatment group demonstrated greater differential activation to Self > Other Contrast at pre-treatment compared to post-treatment (this pattern was reversed for Waitlist; see Table 3 and Figure 3, as an example region in the left insula).”

• Also stated in: § Discussion · plain

  “In the group that received treatment, the difference in insula activation during self- vs other-referential processing decreased from pre- to post-treatment. The opposite finding emerged for the waitlist group.”

Classified as probably not a substantial claim.

The fusiform gyrus is more active when viewing images of one's own face versus another person's face.

“has previously been shown to be more active in responses to images of the self- versus other-face (Sugiura et al., 2005).”

• cites Sugiura et al., 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

People with greater social inhibition show greater extrastriate body area activation when observing threatening versus neutral body movements.

“Individuals with greater levels of social inhibition, or the tendency to inhibit emotional expression in social relationships which often occurs in SAD, demonstrate greater activation of the EBA during observation of threatening versus neutral body movements (Kret et al., 2011).”

• cites Kret et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

People with eating disorders who received treatment showed increased extrastriate body area activation during self- versus other-body processing compared with those who did not receive treatment.

“Specifically, individuals with eating disorders who received treatment demonstrated increased activation in the EBA during self- versus other-body processing relative to individuals who did not receive treatment (Vocks et al., 2011).”

• cites Vocks et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

People with SAD have excessive worry about negative evaluation.

“Social anxiety disorder (SAD) is characterized by excessive concern with negative evaluation (American Psychiatric Association, 2013).”

• cites American Psychiatric Association, 2013Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Video feedback may reduce distorted mental self-representations by offering corrective learning experiences.

“Video-feedback may combat distorted mental representations by providing corrective learning experiences (Harvey et al., 2000).”

• cites Harvey et al., 2000 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Eating disorder treatment might alter sensory processing, as shown by greater activity in regions that process bodily stimuli.

“Thus, treatment for eating disorders may be associated with altered sensory processing, reflected in more activation of brain regions typically associated with processing of bodily stimuli.”

Classified as probably not a substantial claim.

Cortical areas involved in self-referential processing more broadly, especially for stimuli other than videos of the self, show activation in cortical midline structures including medial orbitofrontal cortex, ventromedial prefrontal cortex, dorsomedial prefrontal cortex, dorsal anterior cingulate cortex, and precuneus.

“Cortical areas implicated in self-referential processing more broadly, particularly in stimuli other than videos of the self, have been shown to involve activation of the cortical midline structures (CMS), including the medial orbitofrontal cortex, ventromedial prefrontal cortex (vmPFC), dorsomedial PFC, dorsal anterior cingulate cortex, and precuneus (Northoff et al., 2006).”

• cites Northoff et al., 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Studies have found differential extrastriate body area activity during self-related body processing in anorexia, bulimia, and unspecified eating disorders.

“Differential activation in the EBA has been demonstrated during self-referential body processing in anorexia, bulimia, and unspecified eating disorders.”

• cites Vocks et al., 2011 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

It is unclear whether self-referential bodily processing is altered in SAD or whether such alterations are corrected by treatment.

“However, it is unclear whether self-referential bodily processing is altered in SAD or whether these alterations are corrected in response to treatment.”

May combine two claims.

Participants did not provide behavioral responses during the task, so the study could not confirm that participants were focused on the task.

“Finally, as participants did not provide any behavioral responses during the task, we are unable to confirm that participants were focused on the task.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The LSAS has high internal consistency and good convergent and discriminant validity.

“The LSAS has high internal consistency, as well as good convergent and discriminant validity (Fresco et al., 2001).”

• cites Fresco et al., 2001 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Heightened awareness of bodily cues and sensations is common in individuals predisposed toward anxiety and acts as a trigger for anxious responding, which is associated with heightened amygdala activation.

“Heightened awareness of bodily cues and sensations is both common in individuals predisposed toward anxiety, and acts as a trigger for anxious responding, which is associated with heightened amygdala activation (Paulus and Stein, 2006).”

• cites Paulus and Stein, 2006 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Regressors identifying volumes with large global signal intensity change or motion spikes were included to remove variance in signal due to noise.

“Additionally, regressors identifying individual volumes with large global signal intensity change (outliers thresholded at 2.5 standard deviations from average global signal intensity within the run) or volumes with motion spikes (1.5mm or greater) were included to remove variance in signal due to noise.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

There were only two opportunities for self-observation and other-observation, precluding determination of habituation or other time-course effects over multiple stimulus presentations.

“Second, there were only two opportunities for self-observation as well as for other-observation, precluding an opportunity to determine habituation or other time-course effects over multiple stimulus presentations.”

Classified as probably not a substantial claim. May combine two claims.

For all analyses, cluster-size thresholds were determined using Monte Carlo simulations in AFNI's 3DClustSim, allowing improved assessment of functional activation and correction for multiple comparisons based on a grey matter mask.

“For all analyses, we determined cluster-size thresholds using Monte Carlo simulations in AFNI’s 3DClustSim (http://afni.nimh.nih.gov/afni/) which allowed for improved assessment of functional activation and correction for multiple comparisons (Forman et al., 1995) based on a grey matter mask.”

• cites Forman et al., 1995 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

SAD participants were randomly assigned to CBT, ACT, or waitlist.

“SAD participants were randomized to cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT), or waitlist, and were re-scanned at post-treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The healthy control group had a small sample size due to the larger study's focus on social anxiety disorder.

“The first is the small sample size for the healthy control group, due to the focus in the larger study on social anxiety disorder.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The other-observation included a well-known national news anchor, which might have resulted in differential patterns of activation compared to observation of a novel stimulus.

“Third, the other-observation including the presentation of a well-known national news anchor, which might have resulted in differential patterns of activation compared to the observation of a novel stimulus.”

Classified as probably not a substantial claim.

The insula is involved in interoception and internal awareness of the body.

“The insula is involved interoception and internal awareness of the body (Paulus and Stein, 2006).”

• cites Paulus and Stein, 2006 sourceNot checked — no full text of the source

May combine two claims.

The healthy control group matched the SAD group on age and gender and had no DSM-IV mood or anxiety disorder diagnoses.

“HC (n = 13) were similar to all SAD participants on age and gender and did not meet criteria for any DSM-IV mood or anxiety disorders.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Runs with more than 10% of volumes with large global signal intensity changes or motion spikes were removed from analyses.

“Runs with more than 10% of volumes with large global signal intensity changes or motion spikes were removed from analyses.”