Neural correlates of speech anticipatory anxiety in generalized social phobia

Department of Psychiatry and Center for Advanced Imaging, Medical University of South Carolina Charleston (MUSC), SC 29425, USA.
Neuroreport (Impact Factor: 1.52). 01/2005; 15(18):2701-5.
Source: PubMed


Patients with generalized social phobia fear embarrassment in most social situations. Little is known about its functional neuroanatomy. We studied BOLD-fMRI brain activity while generalized social phobics and healthy controls anticipated making public speeches. With anticipation minus rest, 8 phobics compared to 6 controls showed greater subcortical, limbic, and lateral paralimbic activity (pons, striatum, amygdala/uncus/anterior parahippocampus, insula, temporal pole)--regions important in automatic emotional processing--and less cortical activity (dorsal anterior cingulate/prefrontal cortex)--regions important in cognitive processing. Phobics may become so anxious, they cannot think clearly or vice versa.

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    • "In addition, we hypothesized that the dorsal aspect of the anterior insula (dAI), which is implicated in the processing of arousal, would be active whenever the participant's performance deviated from his/her expectations; thus especially during perceived failures or achievements (Critchley, 2005; Seeley et al., 2007). There is accumulating evidence demonstrating amygdala involvement in various negative and positive emotions (Adolphs et al., 1995; Morris et al., 1998; Phan et al., 2002), and the amygdala is particularly active in a socially evaluative context (Guyer et al., 2008; Lorberbaum et al., 2004). Additionally, meta-analyses of neuroimaging data consistently show that ventral aspects of the anterior insula (vAI), which are densely connected to the amygdala (Mesulam and Mufson, 1982), are central in human affect (Chang et al., 2013; Deen et al., 2011; Kelly et al., 2012). "
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    ABSTRACT: While being in the center of attention and exposed to other's evaluations humans are prone to experience embarrassment. To characterize the neural underpinnings of such aversive moments, we induced genuine experiences of embarrassment during person-group interactions in a functional neuroimaging study. Using a mock-up scenario with three confederates, we examined how the presence of an audience affected physiological and neural responses and the reported emotional experiences of failures and achievements. The results indicated that publicity induced activations in mentalizing areas and failures led to activations in arousal processing systems. Mentalizing activity as well as attention towards the audience were increased in socially anxious participants. The converging integration of information from mentalizing areas and arousal processing systems within the ventral anterior insula and amygdala form the neural pathways of embarrassment. Targeting these neural markers of embarrassment in the (para-)limbic system provides new perspectives for developing treatment strategies for social anxiety disorders. Copyright © 2015. Published by Elsevier Inc.
    NeuroImage 06/2015; 119. DOI:10.1016/j.neuroimage.2015.06.036 · 6.36 Impact Factor
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    • "Most paradigms in imaging studies of SAD to date have compared neural activity in persons with and without the disorder performing tasks related to the core psychopathology, such as viewing of threatening faces (Freitas-Ferrari et al., 2010; Pietrini et al., 2010), performance anticipation (Lorberbaum et al., 2004; Tillfors et al., 2001), eye contact (Schneier et al., 2011), and selfjudgment (Andrews-Hanna et al., 2010; Whitfield-Gabrieli et al., 2011). Evidence from these studies have implicated hyperactivation of neural circuits serving emotion, particularly the amygdala, striatum, insula, hippocampus, fusiform and parahippocampal region (Bruhl et al., 2014a, 2011; Etkin and Wager, 2007; Freitas-Ferrari et al., 2010). "
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    ABSTRACT: Social anxiety disorder (SAD) has received relatively little attention in neurobiological studies. We sought to identify neuro-anatomical changes associated with successful treatment for the disorder. Fourteen patients (31 years; 57% female) with DSM-IV generalized SAD were imaged before and after 8-weeks of paroxetine treatment on a 1.5T GE Signa MRI scanner. Symptoms were assessed by a clinician using the Liebowitz Social Anxiety Scale (LSAS). Longitudinal changes in voxel based morphometry (VBM) were determined using the VBM8 Toolbox for SPM8. Symptom severity decreased by 46% following treatment (p<0.001). At week 8, significant gray matter reductions were detected in bilateral caudate and putamen, and right thalamus, and increases in the cerebellum. Gray matter decreases in left thalamus were correlated with clinical response. This is the first study to our knowledge to identify treatment related correlates of symptom improvement for SAD. Replication in larger samples with control groups is needed to confirm these findings, as well as to test their specificity and temporal stability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research: Neuroimaging 01/2015; 231(3). DOI:10.1016/j.pscychresns.2015.01.008 · 2.42 Impact Factor
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    • "Previous PET and fMRI studies in SAD have demonstrated increased amygdala activity during speech anticipation (Tillfors et al. 2002; Lorberbaum et al. 2004; Etkin & Wager, 2007). However, cortical-amygdala connectivity in SAD during speech anticipation has not been addressed, and, more generally, the role of amygdala activity in prolonged stress states is unclear (Pruessner et al. 2008; Wager et al. 2009b; Choi et al. 2012). "
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    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
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