Neural Mechanisms of Cognitive Reappraisal of Negative Self-Beliefs in Social Anxiety Disorder

Department of Psychology, Stanford University, Stanford, California 94305-2130, USA.
Biological psychiatry (Impact Factor: 10.26). 09/2009; 66(12):1091-9. DOI: 10.1016/j.biopsych.2009.07.014
Source: PubMed


Social anxiety disorder (SAD) is characterized by distorted negative self-beliefs (NSBs), which are thought to enhance emotional reactivity, interfere with emotion regulation, and undermine social functioning. Cognitive reappraisal is a type of emotion regulation used to alter NSBs, with the goal of modulating emotional reactivity. Despite its relevance, little is known about the neural bases and temporal features of cognitive reappraisal in patients with SAD.
Twenty-seven patients with SAD and 27 healthy control subjects (HCs) were trained to react and to implement cognitive reappraisal to downregulate negative emotional reactivity to NSBs, while undergoing functional magnetic resonance imaging and providing ratings of negative emotion experience.
Behaviorally, compared with HCs, patients with SAD reported greater negative emotion both while reacting to and reappraising NSBs. However, when cued, participants in both groups were able to use cognitive reappraisal to decrease negative emotion. Neurally, reacting to NSBs resulted in early amygdala response in both groups. Reappraising NSBs resulted in greater early cognitive control, language, and visual processing in HCs but greater late cognitive control, visceral, and visual processing in patients with SAD. Functional connectivity analysis during reappraisal identified more regulatory regions inversely related to left amygdala in HCs than in patients with SAD. Reappraisal-related brain regions that differentiated patients and control subjects were associated with negative emotion ratings and cognitive reappraisal self-efficacy.
Findings regarding cognitive reappraisal suggest neural timing, connectivity, and brain-behavioral associations specific to patients with SAD and elucidate neural mechanisms that might serve as biomarkers of interventions for SAD.

Download full-text


Available from: Philippe Goldin, Jul 17, 2015
17 Reads
    • "In order to measure distraction as emotion regulation strategy in a comparable way, we added the scale distraction (6 items; Likert scale 1–7) from the Thought Control Questionnaire (Wells et al., 1994) to the standard ERQ items. In addition, besides emotion regulation frequency we assessed emotion regulation self-efficacy (Goldin et al., 2009). Becks Depression Inventory (BDI-II) and Becks Anxiety Inventory (BAI) We used the BDI-II (Hautzinger et al., 2006) to assess depressive symptoms in our participants. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Negative emotions trigger psychotic symptoms, according to a growing body of evidence. Thus, there is a need for effective emotion regulation in schizophrenia. Reappraisal is an effective, cognitive emotion regulation strategy in healthy individuals. However, it is an open research question whether individuals with schizophrenia have difficulties in successfully applying reappraisal. This study experimentally tests the efficacy of reappraisal compared to distraction in patients with schizophrenia and non-clinical controls. An experimental design with group as between-subject factor (non-clinical controls versus patients with schizophrenia) and emotion regulation during anxiety induction as within-subject factor (reappraisal, distraction, no regulation). Seventeen patients with schizophrenia and 27 healthy participants were instructed to respond to anxiety-inducing stimuli by either using reappraisal, distraction or by just watching. Both reappraisal and distraction were effective in down-regulating anxiety, compared to no regulation. The main effect of group and the interaction of emotion regulation condition and group were not significant indicating that the efficacy of both cognitive emotion regulation strategies was independent of group. Patients with schizophrenia are able to apply reappraisal successfully under experimental conditions. Conclusions are limited by the small sample size of this pilot study. Clinical implications for cognitive behavioral therapy for psychosis are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 06/2015; 229(1-2). DOI:10.1016/j.psychres.2015.05.103 · 2.47 Impact Factor
  • Source
    • "Available at: contrast to adult studies (Erk, et al., 2010; Goldin, et al., 2009), however, during instructed reappraisal patients showed greater connectivity between the amygdala and the left medial frontal gyrus (MFG) and subgenual anterior cingulate cortex than controls (Perlman, et al., 2012). Tentatively, these findings suggest that during instructed reappraisal, depressed adolescents seem more able to address their pre-existing ER-difficulties than healthy participants. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is the most common psychiatric disorder in adolescence, and is characterised by an inability to down-regulate negative emotional responses to stress. Adult studies suggest this may be associated with reduced functional connectivity between prefrontal and subcortical regions, yet the neurological mechanisms in adolescence remain unclear. We developed a novel, age-appropriate, reappraisal paradigm to investigate functional connectivity during reappraisal of a real-life source of stress in 15 depressed and 15 non-depressed adolescents. During fMRI, participants i) attended to, and ii) implemented reappraisal techniques (learnt prior to fMRI) in response to, rejection. Reappraisal reduced negative mood and belief in negative thoughts in both groups alike, however during reappraisal (versus attend) trials, depressed adolescents showed greater connectivity between the right frontal pole and numerous subcortical and cortical regions than non-depressed adolescents. These findings tentatively suggest that, when instructed, depressed adolescents do have the ability to engage neural networks involved in emotion regulation, possibly because adolescence reflects a period of heightened plasticity. These data support the value of cognitive reappraisal as a treatment tool, identify neural markers that could be used to optimise current therapies, and lay the foundations for developing novel neuroscientific techniques for the treatment of adolescent depression. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 12/2014; 61. DOI:10.1016/j.jpsychires.2014.11.016 · 3.96 Impact Factor
  • Source
    • "This pattern in connectivity change may reflect failure to recruit adaptive control processes in the face of social stress in SAD. This finding shows similarities with studies that found a link between cortical-amygdala coupling and subjective or physiological responses during the instructed reappraisal of negative emotions (Urry et al. 2006; Wager et al. 2008; Lee et al. 2012) and indications of less cortical-amygdala connectivity during cognitive reappraisal in SAD patients (Goldin et al. 2009b). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Severe stress in social situations is a core symptom of social anxiety disorder (SAD). Connectivity between the amygdala and cortical regions is thought to be important for emotion regulation, a function that is compromised in SAD. However, it has never been tested if and how this connectivity pattern changes under conditions of stress-inducing social evaluative threat. Here we investigate changes in cortical-amygdala coupling in SAD during the anticipation of giving a public speech. Method: Twenty individuals with SAD and age-, gender- and education-matched controls (n = 20) participated in this study. During the functional magnetic resonance imaging (fMRI) session, participants underwent three 'resting-state' fMRI scans: one before, one during, and one after the anticipation of giving a public speech. Functional connectivity between cortical emotion regulation regions and the amygdala was investigated. Results: Compared to controls, SAD participants showed reduced functional integration between cortical emotion regulation regions and the amygdala during the public speech anticipation. Moreover, in SAD participants cortical-amygdala connectivity changes correlated with social anxiety symptom severity. Conclusions: The distinctive pattern of cortical-amygdala connectivity suggests less effective cortical-subcortical communication during social stress-provoking situations in SAD.
    Psychological Medicine 11/2014; 45(07):1-9. DOI:10.1017/S0033291714002657 · 5.94 Impact Factor
Show more