Hostile and threatening interpretation biases in adolescent inpatients are specific to callous-unemotional traits and social anxiety.

Psychopathological syndromes, such as disruptive behavior and anxiety disorders in adolescence, are characterized by distorted cognitions and problematic behavior. Biased interpretations of ambiguous social situations can elicit both aggressive and avoidance behavior. Yet, it is not well understood whether different interpretation biases are specific to different syndromes, or whether they can co-occur. We assessed both hostile and threatening interpretation biases in identical social situations, and proposed that they are uniquely related to callous-unemotional (CU) traits and social anxiety, respectively. We also explored the role of gender and age herein. The sample consisted of 390 inpatients between 10 and 18 years of age with a variety of psychiatric disorders. Hostile and threatening interpretations were assessed with the Ambiguous Social Scenario Task (ASST) consisting of 10 written vignettes. Both CU-traits and social anxiety were assessed with self-report questionnaires. Results showed that, overall, CU-traits were related to more hostile interpretations, whereas social anxiety was related to more threatening interpretations. In addition, in boys, hostile and threatening interpretations correlated significantly positive with each other. Age was not related to interpretation biases. Together, these results generally support the content-specificity of interpretation biases in concepts relevant to disruptive behavior disorders and anxiety disorders, and indicate that different interpretation biases can co-occur specifically in boys.

Specific interpretation biases as a function of social anxiety and callous-unemotional traits in a community and a clinical adolescent sample.

BACKGROUND: Threatening and hostile interpretation biases are seen as causal and maintaining mechanisms of childhood anxiety and aggression, respectively. However, it is unclear whether these interpretation biases are specific to distinct problems or whether they are general psychopathological phenomena. The specificity versus pervasiveness of interpretation biases could also differ depending on mental health status. Therefore, in the current study, we investigated whether social anxiety and callous-unemotional (CU) traits were uniquely related to threatening and hostile interpretation biases, respectively, in both a community and a clinical sample of adolescents. METHODS: A total of 161 adolescents between 10 to 15 years of age participated. The community sample consisted of 88 participants and the clinical sample consisted of 73 inpatients with a variety of psychological disorders. Social anxiety and CU-traits were assessed with self-report questionnaires. The Ambiguous Social Scenario Task was used to measure both threatening and hostile interpretations in response to written vignettes. RESULTS: Results showed that social anxiety was uniquely related to more threatening interpretations, while CU-traits were uniquely related to more hostile interpretations. These relationships were replicated for the community sample. For the clinical sample, only the link between social anxiety and threatening interpretations was significant. Explorative analyses showed that adolescents with externalizing disorders scored higher on hostile interpretations than adolescents with internalizing disorders. CONCLUSIONS: Overall, these results support the content-specificity of threatening interpretation biases in social anxiety and of hostile interpretation biases in CU-traits. Better understanding the roles of interpretation biases in different psychopathologies might open avenues for tailored prevention and intervention paradigms.

The longitudinal link between popularity, likeability, fear of negative evaluation and social avoidance across adolescence.

This study investigated the longitudinal bidirectional associations between likeability, popularity, fear of negative evaluation, and social avoidance, to aid in preventing the negative consequences and persistent trajectories of low social status and heightened social anxiety. In total, 1741 adolescents in grades 7-9 participated at 3 yearly waves. A self-report questionnaire measured fear of negative evaluation. Peer nominations assessed likeability, popularity, and social avoidance. Lower popularity predicted more avoidance, and vice versa. More avoidance was related to lower likeability over time. Being less popular and/or more liked by peers, increased fear of negative evaluation. Support for a transactional model between social anxiety and social status was found, but distinguishing different social status and social anxiety components is necessary.

A New Social Picture Task to Assess Interpretation Bias related to social fears in adolescents.

This pre-registered study focused on developing a new social picture task to assess interpretation bias related to social fears in adolescents. Using such a pictorial task may increase ecological validity and readily trigger emotional processes compared to more traditional verbal tasks that are often used. In the picture task, ambiguous social pictures were presented, followed by a positive and negative interpretation. In this study, we examined how the new task relates to an already existing interpretation bias task and how the new pictorial task relates to social fears in adolescents. The sample consisted of 329 adolescents aged 12 to 18 years. Interpretation bias was assessed with the newly developed pictorial task and with more traditional verbal vignettes. Social fears were measured with self-report questionnaires. The results suggest that the pictorial task was able to assess interpretation bias comparable to the verbal vignettes, suggesting appropriate convergent validity. Interpretation bias assessed with the picture task was linked to higher levels of fear of negative evaluation, the core symptom of social anxiety, but not to social anxiety symptoms in general. The verbal task was linked to both social fears and thus still seems the preferred method to investigate interpretation bias related to social fears in adolescents. However, we do believe that with further improvement of the pictorial task, it could be a useful addition to the research field.

Prospective associations between social status and social anxiety in early adolescence.

This study examined the transactional longitudinal association between social status (likeability and popularity) and social anxiety symptoms (fear of negative evaluation and social avoidance and distress), and explored gender differences in this association. Participants included 274 adolescents (136 boys, Mage  = 12.55). Data were collected at two waves with a 6-month interval. Likeability and popularity were measured with peer nominations and social anxiety symptoms with self-reports. Autoregressive cross-lagged path models showed relative stability of social status and social anxiety. Girls who were seen as less popular by their classmates avoided social situations more frequently and experienced more distress during such situations over time. These results highlight the importance of distinguishing between different social status components and social anxiety symptoms and to take gender into account. Early support for less popular girls seems important to prevent more severe consequences of avoidance and distress, such as social exclusion and victimization.

The role of psychopathic traits, social anxiety and cortisol in social approach avoidance tendencies.

Social anxiety and psychopathy have conceptually been linked to nearly opposite emotional, behavioral and endocrinological endophenotypes, representing social fearfulness and fearlessness, respectively. Although such a dimensional view has theoretical and practical implications, no study has directly compared social anxiety and psychopathy in terms of emotional experiences, relevant hormones (i.e. cortisol, testosterone) and behavioral tendencies (i.e. social approach-avoidance). Therefore, the present study examined 1) whether self-reported social anxiety and psychopathic traits are indeed anticorrelated, and 2) whether social anxiety, psychopathic traits, cortisol, testosterone and their interplay are differentially linked to social approach-avoidance tendencies. In a well-powered study, a sample of 196 healthy female participants, we assessed self-reported emotional and behavioral tendencies of social fear (i.e. social anxiety and social avoidance) and psychopathic traits (i.e. Factor I [interpersonal-affective deficit] and Factor II [impulsive behavior]). Furthermore, hormone levels were assessed, and approach-avoidance tendencies towards emotional (angry, happy) facial expressions were measured by means of a joystick reaction time task. Results confirmed that self-reported emotional tendencies of social anxiety and psychopathy Factor I (interpersonal-affective deficit) correlated negatively, but self-reported behavioral tendencies (social avoidance and psychopathy Factor II [impulsive behavior]) correlated positively. Furthermore, Structural Equation Modelling demonstrated that participants with higher social anxiety and higher cortisol levels showed an avoidance tendency towards happy faces, while participants with higher psychopathic traits showed an approach tendency towards angry faces. In sum, the notion that social anxiety and psychopathic traits are opposing ends of one dimension was supported only in terms of self-reported emotional experiences, but a comparable relationship with regard to behavioral and endocrinological aspects is debatable. The current findings stress the necessity to study emotional, endocrinological and behavioral factors in unison in order to better understand the shared and distinctive mechanisms of social anxiety and psychopathic traits.

Threat-Avoidance Tendencies Moderate the Link Between Serotonin Transporter Genetic Variation and Reactive Aggression.

The short (S) allele of the serotonin transporter-linked promoter region (5-HTTLPR) polymorphism has been linked to reactive aggression in men, but this association is less consistent in females. Reactive aggression has been particularly described as a result of fear-driven defense to threat, but how this interaction between defensive behavior and aggression is expressed in S-allele carriers remains unknown. In order to explore this interplay between 5-HTTLPR genotype, defensive behavior and reactive aggression, we combined genotyping with objective measures of action tendencies toward angry faces in an approach-avoidance task (AAT) and reactive aggression in the Taylor aggression paradigm (TAP) in healthy females, N = 95. This study shows that female S-allele carriers in general display increased implicit reactive aggression (administering aversive white noise) toward opponents. Furthermore, we found that threat-avoidance tendencies moderate the association between 5-HTTLPR genotype and aggression displayed on the TAP. Together, these findings indicate a positive correlation between avoidance of angry faces in the AAT and reactive aggression in the TAP exclusively present in S-allele carriers.

Behavior when socially anxious individuals expect to be (dis)liked: The role of self-disclosure and mimicry in actual likeability.

BACKGROUND AND OBJECTIVES: This study aimed to unravel the relationship between socially anxious individuals' expectation of being (dis)liked and actual likeability by looking at the mediating role of both strategic and automatic social behavior: Self-disclosure as well as mimicry were examined. METHOD: Female participants (N = 91) with various levels of social anxiety participated in a social task with a confederate. Before the task, participants indicated their expectation of being liked by the confederate. Afterwards, objective video-observers rated the likeability of the participants before and after the social task as well as their level of self-disclosure and mimicry. RESULTS: Social anxiety correlated negatively with the expectation to be liked but was not related to observer ratings of likeability, self-disclosure or mimicry. However, degree of social anxiety moderated the relation between expectations and self-disclosure. As expected, participants with low levels of social anxiety disclosed more if they expected to be liked. A reversed pattern was found for the high socially anxious participants: Here, higher expectations of being liked were related to less self-disclosure. LIMITATIONS: The study used an analogue female sample. Our social interaction task was highly structured and does not reflect informal day-to-day conversations. CONCLUSION: Socially anxious individuals function rather well in highly structured social tasks. No support was found for declined likeability or disrupted mimicry. Nevertheless, high socially anxious individuals did have a cognitive bias and show a self-protective strategy: when expecting a neutral judgment they reduce their level of self-disclosure. This pattern probably adds to their feelings of social disconnectedness.

Social Anxiety and Pro-social Behavior Following Varying Degrees of Rejection: Piloting a New Experimental Paradigm.

In general, human beings tend to try and reconnect after they have been socially rejected. It is not clear, however, which role the number of rejecters and rejection sensitivity plays. In addition, it is unclear whether the supposed pro-social behaviors are aimed at the rejecters or at innocent individuals. By means of a new paradigm, the present pilot study investigated compensatory behavior of individuals with varying degrees of social anxiety, following varying degrees of rejection. In addition, it was explored toward whom their behavior was directed: rejecters or innocent individuals. Female students (N = 34) were assessed on their degree of social anxiety and then, based on a personal profile they wrote, they were either rejected by 1, 2, or 3 fictional other participants or completely accepted. Afterward, the participants had to explicitly rate the creativity of drawings made by the others and, in a pro-social reward paradigm, awarded the other participants money based on their creativity rating. In addition, implicit social approach tendencies toward photos of rejecters, acceptors, or innocent individuals were assessed by means of an approach-avoidance task. The results confirmed that people with a low degree of social anxiety respond to rejection in a compensatory pro-social manner explicitly as well as implicitly, but that people with a high degree of social anxiety fail to do so. With regard to sources of rejection, only implicit approach-avoidance tendencies reflected a distinction between rejecters and innocent individuals. Theoretical implications are discussed in the light of the small sample size and other limitations.

DJINNI: A Novel Technology Supported Exposure Therapy Paradigm for SAD Combining Virtual Reality and Augmented Reality.

The present paper explores the benefits and the capabilities of various emerging state-of-the-art interactive 3D and Internet of Things technologies and investigates how these technologies can be exploited to develop a more effective technology supported exposure therapy solution for social anxiety disorder. "DJINNI" is a conceptual design of an in vivo augmented reality (AR) exposure therapy mobile support system that exploits several capturing technologies and integrates the patient's state and situation by vision-based, audio-based, and physiology-based analysis as well as by indoor/outdoor localization techniques. DJINNI also comprises an innovative virtual reality exposure therapy system that is adaptive and customizable to the demands of the in vivo experience and therapeutic progress. DJINNI follows a gamification approach where rewards and achievements are utilized to motivate the patient to progress in her/his treatment. The current paper reviews the state of the art of technologies needed for such a solution and recommends how these technologies could be integrated in the development of an individually tailored and yet feasible and effective AR/virtual reality-based exposure therapy. Finally, the paper outlines how DJINNI could be part of classical cognitive behavioral treatment and how to validate such a setup.

"What I believe is true": Belief-confirming reasoning bias in social anxiety disorder.

BACKGROUND AND OBJECTIVES: Research shows that people tend to consider believable conclusions as valid and unbelievable conclusions as invalid (belief bias). When applied to anxiogenic beliefs, this belief bias could well hinder the correction of dysfunctional convictions. Previous work has shown that high socially anxious students indeed display such fear-confirming, belief biased, reasoning. A critical next question is whether these findings translate to a clinical population of people with social anxiety disorder (SAD). We test whether (i) patients with SAD show belief bias with regard to SAD-relevant themes, (ii) this belief bias is specific for SAD patients or can also be found in panic disorder (PD) patients, (iii) differential belief bias effects in SAD are restricted to social anxiety concerns or are also evident in the context of reasoning with neutral themes. METHOD: 45 SAD patients, 24 PD patients, and 45 non-symptomatic controls (NSCs) completed a syllogistic belief bias task with SAD-relevant and neutral content. RESULTS: SAD patients displayed belief bias for social anxiety related materials, while the PD group and the NSC group did not. Yet, the difference between SAD and PD was not significant. All groups showed similar belief bias effects for neutral content. LIMITATIONS: Content of the belief bias task was not tailored to idiosyncratic beliefs. The study lacked power to detect medium or small differences. CONCLUSIONS: SAD patients showed concern-congruent belief biased interference effects when judging the logical validity of social anxiety relevant syllogisms. Such concern-relevant belief bias may contribute to the persistence of anxiogenic beliefs.

Brain response during the M170 time interval is sensitive to socially relevant information.

Deciphering the social meaning of facial displays is a highly complex neurological process. The M170, an event related field component of MEG recording, like its EEG counterpart N170, was repeatedly shown to be associated with structural encoding of faces. However, the scope of information encoded during the M170 time window is still being debated. We investigated the neuronal origin of facial processing of integrated social rank cues (SRCs) and emotional facial expressions (EFEs) during the M170 time interval. Participants viewed integrated facial displays of emotion (happy, angry, neutral) and SRCs (indicated by upward, downward, or straight head tilts). We found that the activity during the M170 time window is sensitive to both EFEs and SRCs. Specifically, highly prominent activation was observed in response to SRC connoting dominance as compared to submissive or egalitarian head cues. Interestingly, the processing of EFEs and SRCs appeared to rely on different circuitry. Our findings suggest that vertical head tilts are processed not only for their sheer structural variance, but as social information. Exploring the temporal unfolding and brain localization of non-verbal cues processing may assist in understanding the functioning of the social rank biobehavioral system.

Seeing ghosts: negative body evaluation predicts overestimation of negative social feedback.

The current study investigated whether negative body evaluation predicts women's overestimation of negative social feedback related to their own body (i.e., covariation bias). Sixty-five female university students completed a computer task where photos of their own body, of a control woman's body, and of a neutral object, were followed by nonverbal social feedback (i.e., facial crowds with equal numbers of negative, positive, and neutral faces). Afterward, women estimated the percentage of negative, positive, and neutral social feedback that followed their own body, the control woman's body, and the neutral object. The findings provided evidence for a covariation bias: negative body evaluation predicted higher estimates of negative social feedback for women's own body, but not for the other stimuli. Additionally, the covariation bias was not explained by differences in how women interpreted the social feedback (the facial stimuli). Clinical implications of the covariation bias to body image are discussed.

Effects of approach-avoidance training on implicit and explicit evaluations of neutral, angry, and smiling face stimuli.

A growing body of evidence shows that the prolonged execution of approach movements towards stimuli and avoidance movements away from them affects their evaluation. However, there has been no systematic investigation of such training effects. Therefore, the present study compared approach-avoidance training effects on various valenced representations of one neutral (Experiment 1, N = 85), angry (Experiment 2, N = 87), or smiling facial expressions (Experiment 3, N= 89). The face stimuli were shown on a computer screen, and by means of a joystick, participants pulled half of the faces closer (positive approach movement), and pushed the other half away (negative avoidance movement). Only implicit evaluations of neutral-expression were affected by the training procedure. The boundary conditions of such approach-avoidance training effects are discussed.

To be or Not to be Threatening, but What was the Question? Biased Face Evaluation in Social Anxiety and Depression Depends on How You Frame the Query.

Scientific evidence is equivocal on whether Social Anxiety Disorder (SAD) is characterized by a biased negative evaluation of facial expressions, even though it is assumed that such a bias plays a crucial role in the maintenance of the disorder. The way of framing the evaluation question may play an important role in the inconsistencies of earlier results. To investigate this issue, an unselected sample of 95 participants (11 males) with varying degrees of social anxiety and depressive symptoms rated facial crowds with different ratios of neutral-disgust, neutral-sad, neutral-happy, and neutral-surprised expressions in terms of friendliness, approval, difficulty to make contact, and threat. It appeared that the impact of social anxiety on ratings was highly dependent on the type of question that was asked, but not on the type of emotion that was shown: a high degree of social anxiety was related to a more positive evaluation of crowds when friendliness was assessed. When asking about the difficulty to make contact, social anxiety was related to more difficulty. When the threat evoked by a crowd had to be evaluated, higher degrees of social anxiety were tendentiously correlated with higher threat ratings. Degree of depression, on the other hand, was negatively correlated only to approval ratings. In addition, with an increasing degree of depression, the negative impact that any additional emotional face had on approval ratings increased as well. The theoretical and methodological implications of the results are discussed.

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder.

BACKGROUND AND OBJECTIVES: Negative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect. METHODS: We used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively. RESULTS: Results showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women. CONCLUSIONS: These findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.

A neutral face is not neutral even if you have not seen it: social anxiety disorder and affective priming with facial expressions.

Cognitive theories suggest that social anxiety disorder (SAD) is characterized by biased processing of negative facial expressions. Recently, however, it has been proposed that the fear of positive evaluation may play an additional, important role. In order to investigate which specific expressions evoke biased processing, 15 patients diagnosed with SAD and 15 non-anxious controls (NACs) completed an affective priming procedure: they rated neutral symbols which were preceded by sub-optimally presented primes of angry, neutral, and smiling faces. Patients with SAD rated the symbols significantly more negatively than NACs when they were primed with a neutral face. In addition, SAD patients tended to rate all symbols significantly more negatively suggesting that all faces (negative, positive, and neutral) are threatening to SAD patients.

Face value: eye movements and the evaluation of facial crowds in social anxiety.

Scientific evidence is equivocal on whether Social Anxiety Disorder (SAD) is characterized by a biased negative evaluation of (grouped) facial expressions, even though it is assumed that such a bias plays a crucial role in the maintenance of the disorder. To shed light on the underlying mechanisms of face evaluation in social anxiety, the eye movements of 22 highly socially anxious (SAs) and 21 non-anxious controls (NACs) were recorded while they rated the degree of friendliness of neutral-angry and smiling-angry face combinations. While the Crowd Rating Task data showed no significant differences between SAs and NACs, the resultant eye-movement patterns revealed that SAs, compared to NACs, looked away faster when the face first fixated was angry. Additionally, in SAs the proportion of fixated angry faces was significantly higher than for other expressions. Independent of social anxiety, these fixated angry faces were the best predictor of subsequent affect ratings for either group. Angry faces influence attentional processes such as eye movements in SAs and by doing so reflect biased evaluations. As these processes do not correlate with explicit ratings of faces, however, it remains unclear at what point implicit attentional behaviors lead to anxiety-prone behaviors and the maintenance of SAD. The relevance of these findings is discussed in the light of the current theories.