Fear, psychophysiological arousal, and cognitions during a virtual social skills training in social anxiety disorder while manipulating gaze duration.

The use of virtual reality (VR) is an option for social skills training and exposure in Social Anxiety Disorder (SAD). In addition, virtual social situations are an ideal tool to study the influence of a counterpart's social behavior, e. g. eye contact. We developed two scenarios in VR that enable users to practice to assert their rights. The participants' tasks were to ask a passenger to release their reserved seat in a virtual train and to cancel a trip in a virtual travel agency. In a randomized, crossover design, we compared the effect of a large (during 80% of the conversation time) and a small (20%) amount of direct gaze by the virtual conversational partners in 41 patients with SAD and 21 healthy controls (HCs). We expected fear and psychophysiological arousal to be higher in patients than in HCs and higher in the 80% eye contact condition. The scenarios provoked an increase of fear and psychophysiological arousal over baseline in patients and in HCs. Gaze duration of the virtual agent had no influence on fear and psychophysiological arousal, but affected the experience of presence. Our results suggest a suitability of our scenarios for social skills training and exposure therapy in SAD. The lack of influence of gaze duration on parameters of fear might be explained by the fact that participants did not consciously detect the differences in gaze duration. However, the impact on some parameters (e. g. presence) suggests that participants noticed differences in gaze duration on a subliminal level.

Gaze Behavior in Social Fear Conditioning: An Eye-Tracking Study in Virtual Reality.

The vigilance-avoidance hypothesis of selective attention assumes that socially anxious persons initially direct their attention toward fear-related stimuli and subsequently avoid these social stimuli to reduce emotional distress. New technical developments provide tools to implicit measure overt attention on fear-related stimuli via eye-tracking in ecological valid virtual environments presented via a head-mounted display. We examined in 27 low (LSA) and 26 high socially anxious (HSA) individuals fear ratings, physical behavior (duration of approach), hypervigilance (time to first fixation), and attentional avoidance (count of fixations) toward virtual female and male agents (CS) during social fear conditioning (SFC) and extinction in virtual reality (VR). As hypothesized, generally SFC was successfully induced and extinguished concerning the fear ratings. Our findings partly support the vigilance-avoidance hypothesis as HSA directed especially at the first half of the fear acquisition their initial attention more at CS+ than CS- agents, and avoided subsequently the CS+ more than the CS- agents during the fear acquisition. In contrast, in LSA participants initial and sustained attention did not differ between CS+ and CS- agents during fear acquisition. We conclude that HSA individuals guide their initial attention to emotionally threatening stimuli and subsequently avoid the threatening stimuli to possibly reduce their emotional distress, whereas LSA individuals regulate themselves less in their (fear) responses during SFC. Measuring implicit gaze behavior within a well-controlled virtual environment is an interesting innovative tool to in deeply investigate the impact of attention on emotional learning processes.

Men Scare Me More: Gender Differences in Social Fear Conditioning in Virtual Reality.

Women nearly twice as often develop social anxiety disorder (SAD) compared to men. The reason for this difference is still being debated. The present study investigates gender differences and the effect of male versus female agents in low (LSA) and high socially anxious (HSA) participants regarding the acquisition and extinction of social fear in virtual reality (VR). In a social fear conditioning (SFC) paradigm, 60 participants actively approached several agents, some of which were paired with an aversive unconditioned stimulus (US) consisting of a verbal rejection and spitting simulated by an aversive air blast (CS+), or without an US (CS-). Primary outcome variables were defined for each of the 4 levels of emotional reactions including experience (fear ratings), psychophysiology (fear-potentiated startle), behavior (avoidance), and cognition (recognition task). Secondary outcome variables were personality traits, contingency ratings, heart rate (HR), and skin conductance response (SCR). As hypothesized, fear ratings for CS+ increased significantly during acquisition and the differentiation between CS+ and CS- vanished during extinction. Additionally, women reported higher fear compared to men. Furthermore, a clear difference in the fear-potentiated startle response between male CS+ and CS- at the end of acquisition indicates successful SFC to male agents in both groups. Concerning behavior, results exhibited successful SFC in both groups and a general larger distance to agents in HSA than LSA participants. Furthermore, HSA women maintained a larger distance to male compared to female agents. No such differences were found for HSA men. Regarding recognition, participants responded with higher sensitivity to agent than object stimuli, suggesting a higher ability to distinguish the target from the distractor for social cues, which were on focus during SFC. Regarding the secondary physiological outcome variables, we detected an activation in HR response during acquisition, but there were no differences between stimuli or groups. Moreover, we observed a gender but no CS+/CS- differences in SCR. SFC was successfully induced and extinguished according to the primary outcome variables. VR is an interesting tool to measure emotional learning processes on different outcome levels with enhanced ecological validity. Future research should further investigate social fear learning mechanisms for developing more efficient treatments of SAD.

Relating experimentally-induced fear to pre-existing phobic fear in the human brain.

While prior work has demonstrated that fear-conditioning changes the neural representation of previously neutral stimuli, it remains unknown to what extent this new representation abstracts away from specific fears and which brain areas are involved therein. To investigate this question, we sought commonalities between experimentally-induced fear via electric shocks and pre-existing phobia. Using functional MRI, we tested the effect of fear-conditioning pictures of dogs in 21 spider-fearful participants across three phases: baseline, post-conditioning, and extinction. Considering phobic stimuli as a reference point for the state of fear allowed us to examine whether fear-conditioning renders information patterns of previously neutral stimuli more similar to those of phobic stimuli. We trained a classification algorithm to discriminate information patterns of neutral stimuli (rats) and phobic stimuli and then tested the algorithm on information patterns from the conditioned stimuli (dogs). Performing this cross-decoding analysis at each experimental phase revealed brain regions in which dogs were classified as rats during baseline, as spiders following conditioning, and again as rats after extinction. A follow-up analysis showed that changes in visual perception information cannot explain the changing classification performance. These results demonstrate a common neural representation for processing fear-eliciting information, either pre-existing or acquired by classical conditioning.

Social Fear Conditioning Paradigm in Virtual Reality: Social vs. Electrical Aversive Conditioning.

In a previous study we could show that social fear can be induced and extinguished using virtual reality (VR). In the present study, we aimed to investigate the belongingness effect in an operant social fear conditioning (SFC) paradigm which consisted of an acquisition and an extinction phase. Forty-three participants used a joystick to approach different virtual male agents that served as conditioned stimuli. Participants were randomly allocated to one of two experimental conditions. In the electroshock condition, the unconditioned stimulus (US) used during acquisition was an electric stimulation. In the social threat condition, the US consisted of an offense: a spit in the face, mimicked by a sound and a weak air blast to the participant's neck combined with an insult. In both groups the US was presented when participants were close to the agent (75% contingency for CS+). Outcome variables included subjective, psychophysiological and behavioral data. As expected, fear and contingency ratings increased significantly during acquisition and the differentiation between CS+ and CS- vanished during extinction. Furthermore, a clear difference in skin conductance between CS+ and CS- at the beginning of the acquisition indicated that SFC had been successful. However, a fast habituation to the US was found toward the end of the acquisition phase for the physiological response. Furthermore, participants showed avoidance behavior toward CS+ in both conditions. The results show that social fear can successfully be induced and extinguished in VR in a human sample. Thus, our paradigm can help to gain insight into learning and unlearning of social fear. Regarding the belongingness effect, the social threat condition benefits from a better differentiation between the aversive and the non-aversive stimuli. As next step we suggest comparing social-phobic patients to healthy controls in order to investigate possible differences in discrimination learning and to foster the development of more efficient treatments for social phobia.

Treatment effect on biases in size estimation in spider phobia.

BACKGROUND: The current study investigates biases in size estimations made by spider-phobic and healthy participants before and after treatment. METHOD: Forty-one spider-phobic and 20 healthy participants received virtual reality (VR) exposure treatment and were then asked to rate the size of a real spider immediately before and, on average, 15days after the treatment. During the VR exposure treatment skin conductance response was assessed. RESULTS: Prior to the treatment, both groups tended to overestimate the size of the spider, but this size estimation bias was significantly larger in the phobic group than in the control group. The VR exposure treatment reduced this bias, which was reflected in a significantly smaller size rating post treatment. However, the size estimation bias was unrelated to the skin conductance response. CONCLUSION: Our results confirm the hypothesis that size estimation by spider-phobic patients is biased. This bias is not stable over time and can be decreased with adequate treatment.

Social conditioning and extinction paradigm: a translational study in virtual reality.

In human beings, experiments investigating fear conditioning with social stimuli are rare. The current study aims at translating an animal model for social fear conditioning (SFC) to a human sample using an operant SFC paradigm in virtual reality. Forty participants actively (using a joystick) approached virtual male agents that served as conditioned stimuli (CS). During the acquisition phase, unconditioned stimuli (US), a combination of an air blast (5 bar, 10 ms) and a female scream (95 dB, 40 ms), were presented when participants reached a defined proximity to the agent with a contingency of 75% for CS+ agents and never for CS- agents. During the extinction and the test phases, no US was delivered. Outcome variables were pleasantness ratings and physiological reactions in heart rate (HR) and fear-potentiated startle. Additionally, the influence of social anxiety, which was measured with the Social Phobia Inventory scale, was evaluated. As expected after the acquisition phase the CS+ was rated clearly less pleasant than the CS-. This difference vanished during extinction. Furthermore, the HR remained high for the CS+, while the HR for the CS- was clearly lower after than before the acquisition. Furthermore, a clear difference between CS+ and CS- after the acquisition indicated successful conditioning on this translational measure. Contrariwise no CS+/CS- differences were observed in the physiological variables during extinction. Importantly, at the generalization test, higher socially fearful participants rated pleasantness of all agents as low whereas the lower socially fearful participants rated pleasantness as low only for the CS+. SFC was successfully induced and extinguished confirming operant conditioning in this SFC paradigm. These findings suggest that the paradigm is suitable to expand the knowledge about the learning and unlearning of social fears. Further studies should investigate the operant mechanisms of development and treatment of social anxiety disorder.