Elsevier

Psychiatry Research

Volume 275, May 2019, Pages 296-303
Psychiatry Research

Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli

https://doi.org/10.1016/j.psychres.2019.04.001Get rights and content

Highlights

  • Attention bias (AB) is important in the development of SAD and MDD.

  • Interpersonal rejection (IR) influences SAD and MDD.

  • We examined whether after IR, increased SAD would show depressogenic biases.

  • SAD was associated with increased AB for sad faces after IR.

  • IR may be a mechanism by which SAD confers risk for MDD via AB.

Abstract

Social anxiety disorder (SAD) and major depressive disorder (MDD) are comorbid conditions, and SAD confers risk for MDD. Biased attention and interpersonal rejection are important for the development of SAD and MDD, but little research has examined how these processes may lead to MDD. We hypothesized that interpersonal rejection would result in SAD symptoms being associated with more “depression-like” attention biases. Participants (n = 164) completed a measure of SAD symptoms and an eye tracking task before and after a task in which they were randomized to be socially included or rejected. SAD symptoms, inclusion or rejection condition, and the interaction term were entered into separate hierarchical linear regressions predicting change in attention for five emotional faces. Rejection condition significantly moderated the effects of SAD on change in attention to sad, happy, and neutral faces. SAD predicted increased attention to sad faces and decreased attention to happy faces in the rejection condition, but not in the inclusion condition. SAD predicted increased attention to neutral faces in the inclusion condition, but not in the rejection condition. There were no significant effects for angry or disgust. Results suggest that SAD symptoms are associated with more depression-like attention biases in the context of interpersonal rejection.

Introduction

Major depressive disorder (MDD) and social anxiety disorder (SAD) are commonly comorbid disorders (e.g., Kessler et al., 2008, Ohayon and Schatzberg, 2010). Research suggests that SAD confers risk for later MDD (Wittchen et al., 2003). For example, research shows that social anxiety symptoms in adolescence are likely an antecedent of later depression, and that social anxiety is associated with higher depression severity (Stein et al., 2001). Little is known about why SAD confers risk for depression, but it may be because SAD results in, or is associated with, cognitive processes that are depressogenic. For example, a previous study found that the relationship between SAD and MDD was mediated by rumination (Grant et al., 2014). However, little other research has examined the relationship between SAD and potential depressogenic cognitive processes such as biased attention, cross-sectionally.

Biased attention is important for both SAD and MDD (Bantin et al., 2016, Armstrong and Olatunji, 2012) and research investigating biased information processing in SAD and MDD has been ongoing for decades (e.g., Cisler and Koster, 2010, Judah et al., 2013, Mansell et al., 1999, Mattia et al., 1993, Mills et al., 2014, Ingram, 1984, Teasdale, 1988, Gotlib et al., 2004, Wells and Beevers, 2010). Attention bias in SAD is characterized by attention for potentially threatening stimuli (e.g., Rapee and Heimberg, 1997), whereas attention bias in MDD is characterized by increased attention to dysphoric information (Peckham et al., 2010).

Although further study is needed to understand underlying mechanisms of attention bias in SAD and MDD, empirical literature has well documented and characterized cognitive processing biases associated with both SAD and MDD, individually. Given that SAD confers risk for later MDD, we were interested in whether attention bias could help to explain this relationship and what conditions may elicit a more depressogenic bias (e.g., increased attention to dysphoric stimuli) within SAD. Interpersonal rejection is one such condition that may influence cognitive processes in SAD and MDD and that may increase risk for depression.

Social rejection is an important factor for both MDD and SAD. A recent meta-analysis examined emotional states caused by social rejection laboratory tasks and found that individuals who are rejected feel worse than controls, and individuals who are accepted feel better (Blackhart et al., 2009). Furthermore, research suggests that the experience of interpersonal rejection leads individuals to feel increased sadness, loneliness and hurt feelings, all of which are associated with MDD (Leary et al., 2001). Additionally, interpersonal rejection has been implicated as a risk factor for MDD (Slavich et al., 2010). Indeed, empirical research has demonstrated that increased symptoms of depression are associated with strong reactions to social rejection (Nezlek et al., 1997). This line of research suggests that social rejection may play a key role in the development and maintenance of depressive symptoms.

Similarly, research has implicated social rejection as a significant source of social anxiety, and that social rejection appears to be more distressing to individuals with social anxiety compared to those without social anxiety (Leary, 1990, Oaten et al., 2008). Furthermore, the effects of rejection (e.g., interpreting future ambiguous situations as threatening, viewing the rejecting individual in a negative manner), last longer among individuals with higher social anxiety compared to those with lower social anxiety (Zadro et al., 2005). Research has implicated social rejection as a maintaining factor of social anxiety because individuals with higher fears of negative evaluation engage in fewer prosocial behaviors after social rejection compared to those with lower fears of negative evaluation (Maner et al., 2007).

It is apparent that social rejection is important in both social anxiety and depression. Additionally, these experiences are potentially moderated by attention bias (Heeren et al., 2012). Specifically, negative attention bias has been associated with prolonged negative reactions to social rejection (Heeren et al., 2012). A more recent experimental study found that rejection sensitivity (a conferred risk factor for depression) was associated with increased attention to dysphoric stimuli within the context of interpersonal rejection (Kraines et al., 2018). This line of evidence indicates that attentional biases following social rejection may be an avenue for understanding the relationship between SAD and MDD. Specifically, empirical work suggests that social anxiety increases the likelihood an individual will experience social rejection (Maner et al., 2007); furthermore, evidence suggests that social rejection is associated with increased depressive symptoms (Leary et al., 2001) and is a risk factor for MDD (Slavich et al., 2010). To our knowledge, no study has examined attention bias in the context of social rejection among individuals with social anxiety symptoms as evidence for conferred risk for depression (i.e., a depressogenic attention bias).

The aim of the current study was to test whether interpersonal rejection leads social anxiety symptoms to be associated with a more depressogenic attention bias. Given the importance of social rejection in both social anxiety (e.g., Oaten et al., 2008, Zadro et al., 2005) and depression (e.g., Coyne, 1976, Slavich et al., 2010), the current study used a laboratory manipulation of social rejection to examine attention to emotional stimuli. As such, we tested the following core hypothesis: social rejection will manifest the risk for MDD associated with SAD; specifically, we expected that a laboratory task inducing social rejection or inclusion would moderate the relationship between social anxiety symptoms and attention for sad facial expressions, such that individuals in the rejection condition would display a significant positive relationship between social anxiety symptoms and attention for sad faces, but there would be no such relationship for those in the inclusion condition. This prediction was based on literature suggesting that interpersonal rejection in SAD leads to increased negative thinking and other cognitive processes. Additionally, we hypothesized that symptoms of SAD would be associated with baseline attention to threatening faces (i.e., disgust and angry) and symptoms of depression would be associated with baseline attention for sad faces. We did not make a priori hypotheses about individuals in the social inclusion condition, nor did we make a priori hypotheses about baseline attention to happy or neutral faces.

Section snippets

Participants

One hundred eighty undergraduate students were recruited from the student subject pool at a large university. The final sample included 164 participants due to the exclusion of 16 participants due to poor quality eye tracking data (i.e., < 70% valid data). Participants had a mean age of 19.59, and a standard deviation of 2.04. Participants were primarily female (67.1%) and primarily Caucasian (78%). The remaining participants identified as Black or African American (6.7%), American Indian or

Descriptives

Table 1 provides information on the descriptives of the sample on measures of depression symptoms, social anxiety symptoms, and baseline and post-Cyberball eye tracking variables. Table 2 presents correlations of the baseline eye tracking data with social anxiety symptoms and depression symptoms in the overall sample. Table 3 presents correlations between post-Cyberball eye tracking data, social anxiety symptoms and depression symptoms in the overall sample. Table 4 presents correlational data

Discussion

Consistent with our hypothesis, we found that a social rejection or inclusion laboratory task moderated the relationship between social anxiety symptoms and attention for dysphoric faces. Within these results, we found that individuals in the rejection condition exhibited a significant increase in attention to sad faces after being rejected, whereas those in the inclusion condition showed a significant decrease in attention to sad faces after being included. Thus, it appears that social

Declarations of interest

None

Conflict of interest

The authors declare that there are no conflicts of interest.

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