Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Abstract

Self-referential processing is critical to understanding social anxiety disorder (SAD). This study examined neural differences in self-referential processing in healthy controls (HC) and participants with SAD at pre-and post-treatment. Participants (n = 64) underwent fMRI scanning while

Topography of the Anxious Self: Abnormal Rest-Task Modulation in Social Anxiety Disorder

“…others 2011b;Brown and others 2019; Dixon and others 2020;Goldin and Gross 2010). There is also strong evidence for anterior and posterior midline DMN regions showing hyperactivity during attention to internal self-referential cognition as distinguished from external emotional responses(Blair and others 2008a;Blair and others 2011b;Brown and others 2019; Dixon and others 2020; Gaebler and others 2014;Goldin and Gross 2010; Goldin and others 2009a;Pujol and others 2013; Fig. …”

“…DMN regions and especially AMG show hyperactivity during different paradigms applying symptom-sensitive tasks. This can be observed during (1) self-referential stimuli, that is, self-recognition, negative self-beliefs, self-referential comments (Blair and others 2008a; Blair and others 2011b; Brown and others 2019; Dixon and others 2020; Goldin and Gross 2010; Goldin and others 2009a; Yoon and others 2019); (2) social anxious and fearful stimuli, for example, visual scenes, aversive auditory and social stimuli (Blair and others 2010; Boehme and others 2013; Heitmann and others 2016; Heitmann and others 2017; Nakao and others 2011; Quadflieg and others 2008; Schmidt and others 2010; Schneier and others 2011); (3) social cognition tasks like emotional faces paradigm (Gentili and others 2016); (4) disorder-irrelevant stimuli (emotional stimuli without social content, reward anticipation/outcome, human-computer interaction, cognitive tasks; Richey and others 2012; Sareen and others 2007; Shah and others 2009; Sripada and others 2009; Sripada and others 2013).…”

Neurocircuitry of treatment in anxiety disorders

“…In a fourth study, CBT increased activation in the right superior frontal gyrus, inferior parietal lobule, and middle occipital gyrus to social praise; increased activation in the right superior frontal gyrus and inferior parietal lobule to social criticism; decreased activation in the left posterior superior temporal gyrus to social criticism, increased activation in the right superior frontal gyrus, and medial occipital gyrus when using cognitive reappraisal, and decreased activation in the left posterior superior temporal gyrus using cognitive reappraisal ( Goldin et al, 2014 ). Finally, one study examined both CBT and acceptance and commitment therapy (ACT) and found that both treatments decreased activation in the left insula, ACC, left inferior parietal lobule, right inferior parietal lobule, right middle frontal gyrus, and visual cortex when participants watched videos of themselves as compared to videos of others ( Brown et al, 2019 ).…”

“…Additionally, CBT decreased connectivity between left amygdala-right putamen/left dmPFC/right dACC, during resting state, to levels of healthy adults ( Yuan et al, 2016 ). CBT – but not ACT – reversed, from negative to positive, functional connectivity between right amygdala-vmPFC while watching videos of themselves in social situation, and attenuated positive connectivity between these regions while watching others in social situations ( Brown et al, 2019 ). In a grouped analysis of amygdala to whole brain functional connectivity, CBT and ACT enhanced connectivity between right amygdala-visual cortex/-angular gyrus/primary motor cortex/parietal cortex ( Young et al, 2017 ).…”

“…We choose this for a case example as amygdala connectivity has been widely implicated and well-characterized across anxiety disorders ( McTeague et al, 2020 ; Sylvester et al, 2020 ). Seven studies have examined the treatment-related effects on amygdala to whole brain functional connectivity ( Brown et al, 2019 ; Fonzo et al, 2014 ; Lu et al, 2021 ; Månsson et al, 2013 ; Reinecke et al, 2018 ; Young et al, 2017 ; Yuan et al, 2016 ). Of these, three use a sample of patients with social anxiety disorder, one uses a sample of patients with panic disorder, and two use a sample of patients with generalized anxiety disorder, one of which utilized a pediatric population and is the only pharmacotherapy study.…”