Self-report and neurophysiological indicators of emotion processing and regulation in social anxiety disorder
Introduction
Social anxiety disorder (SAD) is characterized by excessive reactivity to negative stimuli. Behavioral studies consistently show evidence of an automatic negative processing bias in SAD; for example, SAD is associated with faster response times relative to healthy controls (HC) on probe detection or Stroop tasks comprising threat stimuli (see Amir & Bomyea, 2010; Bögels & Mansell, 2004 for reviews). Moreover, extensive neuroimaging research in SAD has consistently shown excessive reactivity in regions key to the emotion generative process (e.g., amygdala; see Brühl, Delsignore, Komossa, & Weidt, 2014 for a meta-analysis).
In addition to excessive reactivity to negative stimuli, individuals with SAD have difficulty managing emotions. Well-studied emotion regulation strategies include reappraisal and suppression. Reappraisal is considered to be an adaptive strategy that entails altering the way one thinks about a situation to modify the emotional response that would otherwise occur, whereas suppression, a maladaptive strategy, involves avoiding the expression of emotions (Gross, 2002). Several studies have found individuals with SAD report they rely on reappraisal less frequently (Blalock, Kashdan, & Farmer, 2016; D’Avanzato, Joormann, Siemer, & Gotlib, 2013; Jazaieri, Goldin, & Gross, 2017; Kivity & Huppert, 2018a) and suppression more frequently (e.g., D’Avanzato et al., 2013; Dryman & Heimberg, 2018; Jazaieri et al., 2017; Kivity & Huppert, 2018a; Spokas, Luterek, & Heimberg, 2009; Turk, Heimberg, Luterek, Mennin, & Fresco, 2005) than HC. Additionally, literature suggests SAD is characterized by ineffective use of reappraisal (see Dryman & Heimberg, 2018 for a review). Furthermore, neuroimaging studies show that individuals with SAD (relative to HC) show attenuated brain activation in regions associated with cognitive control (e.g., dorsolateral prefrontal cortex) during online reappraisal (e.g., Goldin, Manber, Shabnam, Canlie, & Gross, 2009).
Intriguingly, few studies have taken a neurophysiological approach towards understanding the processing and regulation of negative information in SAD. Event-related potentials (ERPs) use an electroencephalography (EEG) signal that is time-locked to specific events, have excellent temporal resolution, and can be used as an objective measure of emotion processing and regulation (Hajcak, MacNamara, & Olvet, 2010). Specifically, the late positive potential (LPP) is a reliable (Auerbach et al., 2016; Huffmeijer, Bakermans-Kranenburg, Alink, & van IJzendoorn, 2014; Kujawa, Klein, & Proudfit, 2013) ERP elicited by emotional stimuli which is typically analyzed using several time windows following stimulus onset to examine changes in emotion processing over time (Cuthbert, Schupp, Bradley, Birbaumer, & Lang, 2000; Hajcak et al., 2010; Schupp et al., 2000). In unselected samples, the LPP amplitude is positively correlated with self-reported affective arousal (Cuthbert et al., 2000) and is, therefore, considered an index of emotional intensity (Hajcak et al., 2010). Furthermore, the LPP has been shown to decrease as a result of reappraising negative images compared to viewing negative images (Hajcak & Nieuwenhuis, 2006; Moser, Most, & Simons, 2010; Parvaz, MacNamara, Goldstein, & Hajcak, 2012). Additionally, the degree of the LPP reduction during reappraisal was associated with reductions in self-reported ratings of emotional intensity (Hajcak & Nieuwenhuis, 2006). Altogether, the LPP can also be considered an index of online reappraisal facility.
To our knowledge, only one study has examined LPP to negative stimuli in adults with SAD. Kivity and Huppert (2018a) found no group differences between SAD and HC in either online emotion reactivity or regulation (i.e., reappraisal, suppression) in response to shame and rejection related stimuli, and they found no difference in the LPP amplitude by condition (i.e., between reappraising and viewing negative images). Since the LPP is closely linked to emotional arousal (Cuthbert et al., 2000), the authors hypothesize the shame and rejection stimuli may affect the valence of an individual’s emotional response, but not the arousal level. Additionally, a meta-analysis found that although individuals high in social anxiety self-report less frequent and self-report less effective use of reappraisal compared to individuals low in social anxiety, there was a trend toward larger reappraisal-related reductions in emotional arousal in individuals high in social anxiety compared to those low in social anxiety during a lab-based emotion regulation task, but again there were no group differences in the LPP (Kivity & Huppert, 2018b). In contrast, one study found that youth with anxiety disorders displayed enhanced LPP to threatening faces relative to HC (Kujawa, MacNamara, Fitzgerald, Monk, & Phan, 2015), and the effect was driven by SAD, signifying an exaggerated emotional response in socially anxious youth. Moreover, evidence suggests individuals low in social anxiety are better able attend to and prepare for upcoming emotion regulation tasks compared to individuals high in social anxiety (Yuan, Zhou, & Hu, 2014). Thus, limited studies have revealed inconsistent findings; further research is needed to clarify the effect of SAD on the LPP during emotion reactivity and regulation. Moreover, to our knowledge, no study has examined the relationship between self-reported habitual emotion regulation and the LPP during emotion reactivity or regulation in patients with SAD. However, one study found that habitual reappraisal was correlated with decreased reappraisal-related LPP amplitude in a college sample (Moser, Hartwig, Moran, Jendrusina, & Kross, 2014), which has clinical implications.
The current study aims to extend the literature by 1) replicating previous findings regarding group differences in self-reported habitual reappraisal and suppression, 2) investigating group differences in the LPP in response to negative images in individuals with SAD and HC during emotion reactivity and reappraisal, and 3) examining associations between self-reported reappraisal and suppression tendencies and the LPP during emotion reactivity and online reappraisal. Based on literature and theory, we hypothesized the SAD group would self-report lower reappraisal frequency and higher suppression frequency than HC. We also hypothesized the SAD group would display greater LPP amplitude in response to negative images (i.e., greater emotion reactivity) in comparison to the HC group, but that compared to the SAD group, the HC group would show lower LPP during reappraisal. We hypothesized greater habitual reappraisal would correlate with lower LPP amplitude during online reappraisal. We had no hypothesis regarding the relationship between habitual suppression and the LPP during emotion reactivity and reappraisal, given the absence of previous studies on this topic.
Section snippets
Participants
Fifty-seven individuals with SAD were identified through local community advertisements and referrals from an outpatient psychiatric clinic based on presenting complaint, prior to initiating treatment. Thirty-four HCs were recruited through community advertisements. Participants completed a consent form approved by the local Institutional Review Board. All participants met with a master’s-level clinician who performed the Structured Clinical Interview for DSM-IV (First, Spitzer, Gibbon, &
Results
See Table 3 and Fig. 1 for the mean LPP amplitude by group, condition. Scalp distributions by Group, Condition, and Time are included in the Supplementary Materials.
Discussion
In the current study, we examined self-reported habitual emotion regulation tendencies (i.e., reappraisal, suppression) together with the LPP during an emotion regulation task in patients with SAD and HCs. As predicted, SAD patients reported less frequent reappraisal use and more frequent suppression use compared to HCs. The SAD group displayed heightened LPP during emotion processing (i.e., ‘Look Negative’) in the late time window compared to HCs. There was no group difference in LPP during
Conflicts of interest
The authors have no conflicts of interest to report
Acknowledgements
This work was supported by the National Institute of Mental HealthK23MH093679 (HK), R01MH112705 (HK), and the Center for Clinical and Translational Research (CCTS)UL1RR029879.
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2023, Clinical NeurophysiologyCitation Excerpt :For sham condition, stimulation was turned off following a 30 second ramp-up period. Participants completed several iterations of a validated ERT (Fitzgerald et al., 2016; Kinney et al., 2019), previously used while studying the theta band during emotion regulation (Xing et al., 2019). Each iteration consisted of 6 blocks of 20 novel stimuli presented in pseudorandomized order, during which participants were instructed to look at neutral images (‘look’), maintain negative affect while viewing negative images (‘maintain’), or reappraise negative images to reduce negative affect (‘reappraise’).