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.

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Available from: Philippe Goldin, Jul 17, 2015
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    • "In contrast to past studies (Gaebler et al., 2014;Goldin et al., 2009b;Hayes-Skelton & Graham, 2013), HSAs did not report using reappraisal less often than LSAs, as measured by the ERQ and in daily stressful situations. In addition, similar to past studies (Goldin et al., 2009b), HSAs did perceive themselves as less successful in using reappraisal in general (i.e., on the ERQ) and in daily stressful situations, even though they reported putting more effort in implementing reappraisal in daily stressful situations. Despite the differences in perceived self-efficacy in reappraisal, there were no differences in actual success in reappraisal on a lab based behavioral measure (a finding similar to previous studies) and, while use of reappraisal was not associated with lower ratings of anxiety in daily stressful situations forHSAs, forLSAs it was associated with even greater anxiety (during but not before or after the situation). "
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    ABSTRACT: Objective: To examine emotion regulation (ER) among individuals with high (HSA) and low social anxiety (LSA) and the effects of 1 week of practiced cognitive reappraisal using self-report, daily diary measures and lab tasks. Method: HSAs received reappraisal (HSA-R; n = 43) or monitoring (HSA-M; n = 40) instructions. LSAs received monitoring instructions (LSA-M; n = 41). Self-report measures of social anxiety and ER, and a lab task of reappraisal were administered at baseline and after 1 week. Daily diaries of anxiety and ER were also collected. Results: At baseline, HSAs compared with LSAs reported lower self-efficacy of reappraisal and higher frequency and self-efficacy of suppression, but no differences emerged in the reappraisal task. Following the intervention, the HSA-R compared with the HSA-M reported lower symptom severity, greater self-efficacy of reappraisal but equal daily anxiety. HSA-R used reappraisal mostly combined with suppression (74.76% of situations). Post hoc analyses demonstrated that clinical diagnosis, but not severity, moderated the intervention effect. Conclusions: The results demonstrate the efficacy of a short intervention in social anxiety, and provide additional areas of research for improving its treatment. (PsycINFO Database Record
    Full-text · Article · Jan 2016 · Journal of Consulting and Clinical Psychology
    • "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. "
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    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.
    No preview · Article · Jun 2015 · Psychiatry Research
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    • "Behavioral studies have observed that compared to controls, individuals with SAD report lesser " reappraisal self-efficacy " when challenged to give a speech or recall autobiographical social anxiety situations (Werner et al., 2011). Neuroimaging studies have found that, compared with healthy controls, individuals with SAD generate lesser brain responses in cognitive control (DLPFC and DMPFC) and attention (medial precuneus, posterior cingulate, and bilateral dorsal parietal cortex) brain networks during reappraisal of harsh facial expressions (Goldin, Manber, Hakimi, Canli, & Gross, 2009), as well as temporally delayed prefrontal cortex activation (DMP- FC, bilateral DLPFC, and bilateral VLPFC) and less PFC-amygdala inverse functional connectivity when reappraising self-generated negative self-beliefs (Goldin, Manber-Ball, et al., 2009). Thus, lesser and slower recruitment of cognitive control networks in SAD is related to less successful cognitive downregulation of limbic responses. "
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    ABSTRACT: Individuals with social anxiety disorder (SAD) suffer from intense fear of social evaluation, heightened emotional reactivity to social cues, and problems implementing effective forms of emotion regulation (ER), particularly in social situations. In this chapter, we examine the role of emotion and ER in SAD to elucidate how different families of ER strategies function in individuals with SAD, and are modified by clinical interventions for SAD, specifically, cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR).
    Full-text · Article · Dec 2014
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