Attentional heterogeneity in social anxiety disorder: Evidence from Hidden Markov Models.

There is some evidence for heterogeneity in attentional processes among individuals with social anxiety. However, there is limited work considering how attentional processes may differ as a mechanism in a naturalistic task-based context (e.g., public speaking). In this secondary analysis we tested attentional heterogeneity among individuals diagnosed with social anxiety disorder (N = 21) in the context of a virtual reality exposure treatment study. Participants completed a public speaking challenge in an immersive 360°-video virtual reality environment with eye tracking at pre-treatment, post-treatment, and at 1-week follow-up. Using a Hidden Markov Model (HMM) approach with clustering we tested whether there were distinct profiles of attention pre-treatment and whether there were changes following the intervention. As a secondary aim we tested whether the distinct attentional profiles at pre-treatment predicted differential treatment outcomes. We found two distinct attentional profiles pre-treatment that we characterized as audience-focused and audience-avoidant. However, by the 1-week follow-up the two profiles were no longer meaningfully different. We found a meaningful difference between HMM groups for fear of public speaking at post-treatment b = -8.54, 95% Highest Density Interval (HDI) [-16.00, -0.90], Bayes Factor (BF) = 8.31 but not at one-week follow-up b = -5.83, 95% HDI [-13.25, 1.81], BF = 2.28. These findings provide support for heterogeneity in attentional processes among socially anxious individuals, but our findings indicate that this may change following treatment. Moreover, our results offer preliminary mechanistic evidence that patterns of avoidance may be specifically related to poorer treatment outcomes for virtual reality exposure therapy.

Genetic and hormonal sensitivity to threat: testing a serotonin transporter genotype × testosterone interaction.

BACKGROUND: Striking parallels are observed when comparing the literature on the 5-HTTLPR of the serotonin transporter gene (SLC6A4) to the testosterone (T) literature on measures of stress reactivity and neural activity. Short (S) allele carriers and individuals higher in testosterone levels show exaggerated stress responses, amygdala hyperactivity, and reduction of amygdala-prefrontal cortex coupling when exposed to threat. METHODS: Three studies tested the hypothesis that higher T, S carriers would show increased cortisol responses to threat. RESULTS: Supporting the hypothesis, a T × 5-HTTLPR interaction was obtained across all studies. Threats to status via social exclusion (Study 1), cognitive/perceptual failure (Study 2), and physical competence (Study 3) all produced elevated cortisol levels in S carriers with higher T levels. An unexpected result was that 5-HTTLPR long (L) allele homozygotes with higher T showed lower cortisol levels in response to threat-a pattern of response that closely parallels that reported for psychopathic individuals. Finally, combining effect sizes across studies showed that the likelihood that these effects were due to Type 1 errors was quite low. CONCLUSIONS: What emerges from these studies is a novel yet reliable, and synergistic relationship between 5-HTTLPR genotype and testosterone on stress reactivity, possibly conferring vulnerability for multiple neuropsychiatric disorders.

The Combat Experience Log: a web-based system for the in theater assessment of war zone stress.

This article presents preliminary data on the Combat Experience Log (CEL)--a web-based prospective data collection system for the in theater assessment of war zone stressors and stress reactions. 177 U.S. Army soldiers deployed to Iraq took part in the study. The overall response rate was 90.1% and the majority of CEL responders perceived the CEL system to be quite easy and convenient to use, and relevant to their war-zone experiences. Preliminary data on stress reactions, CEL utilization and soldier satisfaction are encouraging and suggest that the CEL assessment system offers a potentially useful assessment tool for enhancing our understanding of war-zone stress experiences and their contribution to PTSD and other combat stress disorders.

Appraisal of social concerns: a cognitive assessment instrument for social phobia.

The current study describes the validation of a new cognitive assessment measure for social phobia, entitled the Appraisal of Social Concerns (ASC). Item content is relevant to a range of social situations. The ASC can be used to tailor interventions to patients' idiosyncratic concerns. Data are presented from both clinical (n = 71) and non-clinical (n = 550) samples. Preliminary data indicate that the ASC has good internal consistency and test-retest reliability. The construct validity of the ASC is comparable to that of well-established measures in use with social phobics. A strength of the ASC is its sensitivity to the effect of treatment. An exploratory factor analysis yielded three factors tapping concerns about negative evaluation, observable symptoms, and social helplessness. Subscale scores were strongly correlated. Preliminary findings suggest that the ASC is a psychometrically sound, time efficient instrument that can be used for both clinical and research purposes.