Hostile attributional biases in severe alcohol use disorder: replication, gender specificity, and mechanistic insights.

AIMS: Despite their importance in the emergence and persistence of severe alcohol use disorder (SAUD), social cognition impairments remain understudied in this population. Hostile attributional biases (HAB), a key component of social cognition, may be involved in interpersonal problems and SAUD maintenance. However, current evidence for HAB in SAUD is highly preliminary, as it relies on a single study based on a small sample and on a task that cannot dissociate increased hostile from reduced benign attributions. We therefore used an improved methodology to further characterize this bias and disentangle underlying mechanisms. In addition, we explored potential gender differences. METHOD: A total of 56 patients (28 women) diagnosed with SAUD and 66 (27 women) demographically matched controls completed the Word-Sentence Association Paradigm-Hostility, which provides a valid, spontaneous, and relatively implicit assessment of both hostile and benign social attributions related to ambiguous situations. They also completed self-report measures of psychopathology and interpersonal problems. RESULTS: At the group-level, patients with SAUD presented higher HAB than controls, without group differences for benign attributions. Gender analyses revealed that this effect selectively emerged in men with SAUD. Further, patients' benign attributions did not differ from their hostile attributions. Finally, HAB (not benign attributions) were associated with interpersonal problems and state anxiety in patients. CONCLUSIONS: The association between SAUD and HAB at the group level is genuine and replicable across samples and tasks. This association may further selectively emerge in men. Our results also confirm the functional significance of HAB in SAUD, and point to potential mechanisms and clinical recommendations.

Altered attentional processing of facial expression features in severe alcohol use disorder: An eye-tracking study.

Social cognition impairments, and notably emotional facial expression (EFE) recognition difficulties, as well as their functional and clinical correlates, are increasingly documented in severe alcohol use disorder (SAUD). However, insights into their underlying mechanisms are lacking. Here, we tested if SAUD was associated with alterations in the attentional processing of EFEs. In a preregistered study, 40 patients with SAUD and 40 healthy controls (HCs) had to identify the emotional expression conveyed by faces while having their gaze recorded by an eye-tracker. We assessed indices of initial (first fixation locations) and later (number of fixations and dwell-time) attention with reference to regions of interest corresponding to the eyes, mouth, and nose, which carry key information for EFE recognition. We centrally found that patients had less first fixations to key facial features in general, as well as less fixations and dwell time to the eyes specifically, relative to the rest of the face, compared to controls. These effects were invariant across emotional expressions. Additional exploratory analyses revealed that patients with SAUD had a less structured viewing pattern than controls. These results offer novel, direct, evidence that patients with SAUD's socioaffective difficulties already emerge at the facial attentional processing stage, along with precisions regarding the nature and generalizability of the effects. Potential implications for the mechanistic conceptualization and treatment of social cognition difficulties in SAUD are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Rejection sensitivity in severe alcohol use disorder: Increased anxious anticipation of rejection.

Rejection sensitivity (RS) reflects the disposition to anxiously expect, readily perceive, and disproportionately react to rejection. It is linked to interpersonal problems and psychopathological symptoms, which are frequent in severe alcohol use disorder (SAUD) and are known to influence clinical outcomes. Consequently, RS has been put forward as a process of interest in this disorder. However, empirical studies investigating RS in SAUD are scarce and focused on its last two components, leaving the core process of anxious expectations of rejection unexplored. To fil this gap, 105 patients with SAUD and 73 age-and-gender-matched controls completed the validated Adult Rejection Sensitivity Scale. We computed anxious anticipation (AA), and rejection expectancy (RE) scores, corresponding to the affective and cognitive dimensions of anxious expectations of rejection, respectively. Participants also completed measures of interpersonal problems and psychopathological symptoms. We found that patients with SAUD had higher AA (affective dimension) but not RE (cognitive dimension) scores. Moreover, AA was associated with interpersonal problems as well as psychopathological symptoms in the SAUD sample. These findings meaningfully extend the RS and social cognition literatures in SAUD by showing that difficulties already arise at the anticipatory stage of socio-affective information processing. Moreover, they shed light on the affective component of anxious expectations of rejection as a novel, clinically relevant process in this disorder.

Tasks and investigated components in social cognition research among adults with alcohol use disorder: A critical scoping review.

OBJECTIVE: Social cognition research in alcohol use disorder (AUD) has accumulated over the past decades and has implications for understanding the interpersonal problems reported in this population and for improving clinical outcomes. However, recent criticism of classically used social cognition tasks calls for an evaluation of social cognition assessments in AUD. Moreover, available literature reviews focus on a restricted subset of social cognition components, leaving the outcomes and significance of studies assessing the remaining components unknown. Hence, to qualify and broaden our understanding of the available evidence and identify research perspectives, we systematically charted and critically appraised the tasks used and social cognition components investigated in AUD. METHOD: We searched databases for studies comparing patients with AUD and healthy controls on behavioral social cognition assessments. We extracted the number of times specific social cognition components were investigated and the tasks assessing them. RESULTS: Of the 74 included records, 58 investigated emotion recognition, 14 investigated theory of mind (ToM), three investigated social perception/knowledge, and two investigated attributional biases. Most emotion recognition tasks required complex categorization, and presented unimodal static and context-free emotional stimuli among verbal labels. ToM was mostly assessed with the reading the mind in the eyes and faux-pas tests. CONCLUSIONS: Emotion recognition and ToM have been extensively investigated yet most tasks are multidetermined, lack ecological validity, or fail to assess the targeted ability. Conversely, social perception/knowledge and attributional biases, despite their clear relevance to AUD, are insufficiently studied. We propose concrete ways to address these issues. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social perception and knowledge impairments in severe alcohol use disorder: Group and individual-level findings.

BACKGROUND: Consistent data highlight the presence and clinical significance of social cognition impairments in severe alcohol use disorder (SAUD). However, social perception and knowledge (i.e., the ability to interpret social situations and to identify latent social rules), an important social cognition component, has not yet been explored in this disorder. METHOD: 35 patients with SAUD and 35 healthy controls (HC) completed the Social Perception and Knowledge test (PerSo), an experimental task requiring participants to comprehensively describe social situations and to identify the social rules illustrated in 8 pictures. We performed group and single-case analyses. RESULTS: Patients with SAUD, as a group, spontaneously identified less relevant "where"/"who"/"what" aspects of the social situations (social perception) than HC. They were however able to provide these elements when explicitly asked to. They were also less able to identify the social rules that subtended the situations (social knowledge). Single-case analyses revealed that 23 % of patients were significantly impaired for social perception, and 34 % for social knowledge. DISCUSSION: We provide novel evidence that SAUD is associated with social perception and knowledge impairments at the group level, and that these impairments strongly vary across patients. Such results should lead to the integration of social perception and knowledge impairments in the conceptualization and treatment of socio-affective difficulties in SAUD.

Social decision making in severe alcohol use disorder: Scoping review and experimental perspectives.

BACKGROUND: Patients with severe alcohol use disorder (SAUD) demonstrate multifaceted impairments in social cognition abilities, including emotional decoding or Theory of Mind. Such impairments are associated with real-life interpersonal difficulties, which in turn could contribute to the persistence of SAUD. However, little is known regarding how patients with SAUD make decisions in a social context and this literature has not been comprehensively reviewed. OBJECTIVES: The main aim of this paper was to conduct the first review specifically focusing on social decision-making abilities in SAUD. Following PRISMA guidelines for scoping reviews, we describe existing knowledge regarding the difficulties experienced by patients with SAUD during social interactions. Our second objective was to propose perspectives for future research, based on the shortcomings identified in the available literature. DESIGN: We searched three online databases (PubMed, PsycINFO, and Scopus) and identified 14 papers using behavioral tasks to assess social decision making in patients with SAUD. RESULTS: Included studies assessed social decision making through three paradigms: (1) economic games (four papers), (2) moral dilemmas (four papers), and (3) interpersonal problem-solving (six papers). Results indicated that patients with SAUD behave differently from controls in all three paradigms. CONCLUSIONS: Previous studies suggested large-scale social decision-making impairments or biases in SAUD. However, in light of the limited number of studies available and of the restricted set of processes measured, we call for the extension of this field through more ecologically relevant and model-based paradigms in order to elucidate the underlying mechanisms of these effects.