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The most important life goals of people with and without social anxiety disorder: Focusing on emotional interference and uncovering meaning in life

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Abstract

People with social anxiety disorder (SAD) display maladaptive attitudes towards emotions. In this experience-sampling study, we explored the extent to which people with SAD viewed anxiety and pain as an impediment to pursuing personal strivings and deriving meaning in life. Participants were adults diagnosed with SAD and a control comparison group who completed baseline questionnaires and daily surveys for 14 consecutive days. People with SAD perceived anxiety and pain as interfering with progress towards their strivings to a greater degree than healthy controls. Perception of emotion-related goal interference was inversely associated with daily meaning. This relationship was moderated by diagnostic group such that there was a strong, inverse association with daily meaning in life for people with SAD; for controls, no association was found. Results suggest that negative beliefs about the value of anxiety and pain are pronounced in people with SAD and may impede derivation of meaning in life.

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... Furthermore, everyone's adjustment during the COVID-19 pandemic is impacted by the unique encounters they have had with specific COVID-related stressors, such as becoming ill, caring for dependents, or losing employment, which have been associated with increased stress, anxiety, depression, and functional impairment (Dozois, 2020;Gallagher et al., 2020). COVID-related stressors may differentially impact socially anxious individuals, as certain cognitive biases may make it difficult for them to feel well-equipped to handle stress: compared to healthy controls, individuals with SAD were found to perceive anxiety and pain as more interfering with progress towards their goals regardless of how much effort and progress they actually made (Goodman & Kashdan, 2021). Furthermore, after controlling for symptom severity, individuals with SAD were more likely to hold entity beliefsbeliefs that emotions are fixed and not amenable to changein relation to their own emotions and anxiety (De Castella et al., 2014), suggesting that SA individuals may be less effective at coping in the face of increased anxiety and stressors, such as those caused by the pandemic. ...
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Background and objectives: Individuals with social anxiety (SA) have well-established fears of being negatively evaluated and of exposing self-perceived flaws to others. However, the unique impacts of pre-existing SA on well-being and interpersonal outcomes within the stressful context of the pandemic are currently unknown. Design: In a preregistered study that took place in May 2020, we surveyed 488 North American community participants online. Methods: We used multiple linear regression to analyze whether pre-existing SA symptoms predicted current coronavirus anxiety, loneliness, fears of negative evaluation, use of preventive measures, and affiliative outcomes, and whether pre-existing functional impairment and recent COVID-related stressors moderated these relations. Results: Results highlighted the negative effects of pre-existing social anxiety (SA) on current mental health functioning, especially for participants with higher pre-existing functional impairment and greater exposure to COVID-related stressors. Although participants with higher pre-existing SA reported currently feeling lonelier and more fearful of negative evaluation, they also endorsed greater efforts to affiliate with others. Conclusions: High SA individuals may have heightened desire for social support within the isolating context of the pandemic, in which COVID-related social restrictions enable greater avoidance of social evaluation but may also mask the enduring impairment associated with pre-existing SA.
... Furthermore, everyone's adjustment during the COVID-19 pandemic is impacted by the unique encounters they have had with specific COVID-related stressors, such as becoming ill, caring for dependents, or losing employment, which have been associated with increased stress, anxiety, depression, and functional impairment (Dozois, 2020;Gallagher et al., 2020). COVID-related stressors may differentially impact socially anxious individuals, as certain cognitive biases may make it difficult for them to feel well-equipped to handle stress: compared to healthy controls, individuals with SAD were found to perceive anxiety and pain as more interfering with progress towards their goals regardless of how much effort and progress they actually made (Goodman & Kashdan, 2021). Furthermore, after controlling for symptom severity, individuals with SAD were more likely to hold entity beliefsbeliefs that emotions are fixed and not amenable to changein relation to their own emotions and anxiety (De Castella et al., 2014), suggesting that SA individuals may be less effective at coping in the face of increased anxiety and stressors, such as those caused by the pandemic. ...
Article
Background and objectives Individuals with social anxiety (SA) have well-established fears of being negatively evaluated and exposing self-perceived flaws to others. However, the unique impacts of pre-existing SA on well-being and interpersonal outcomes within the stressful context of the pandemic are currently unknown. Design In a study that took place in May 2020, we surveyed 488 North American community participants online. Methods We used multiple linear regression to analyze whether retrospective reports of pre-pandemic SA symptoms predicted current coronavirus anxiety, loneliness, fears of negative evaluation, use of preventive measures, and affiliative outcomes, and whether pre-pandemic functional impairment and recent COVID-related stressors moderated these relations. Results Results highlighted the negative effects of pre-pandemic SA on current mental health functioning, especially for participants with higher pre-pandemic functional impairment and greater exposure to COVID-related stressors. Although participants with higher pre-pandemic SA reported currently feeling lonelier and more fearful of negative evaluation, they also endorsed greater efforts to affiliate with others. Conclusions High SA individuals may have heightened desire for social support within the isolating context of the pandemic, in which COVID-related social restrictions enable greater avoidance of social evaluation but may also mask the enduring impairment associated with pre-pandemic SA.
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A theory of ironic processes of mental control is proposed to account for the intentional and counterintentional effects that result from efforts at self-control of mental states. The theory holds that an attempt to control the mind introduces 2 processes: (a) an operating process that promotes the intended change by searching for mental contents consistent with the intended state and (b) a monitoring process that tests whether the operating process is needed by searching for mental contents inconsistent with the intended state. The operating process requires greater cognitive capacity and normally has more pronounced cognitive effects than the monitoring process, and the 2 working together thus promote whatever degree of mental control is enjoyed. Under conditions that reduce capacity, however, the monitoring process may supersede the operating process and thus enhance the person's sensitivity to mental contents that are the ironic opposite of those that are intended.
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Social anxiety disorder (SAD) is one of the most common and impairing psychological disorders. To advance our understanding of SAD, several researchers have put forth explanatory models over the years, including one which we originally published almost two decades ago (Rapee & Heimberg, 1997), which delineated the processes by which socially anxious individuals are affected by their fear of evaluation in social situations. Our model, as revised in the 2010 edition of this text, is summarized and further updated based on recent research on the multiple processes involved in the maintenance of SAD.
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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.
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Experiential avoidance (EA), the tendency to avoid internal, unwanted thoughts and feelings, is hypothesized to be a risk factor for social anxiety. Existing studies of experiential avoidance rely on trait measures with minimal contextual consideration. In two studies, we examined the association between experiential avoidance and anxiety within real-world social interactions. In the first study, we examined the effect of experiential avoidance on social anxiety in everyday life. For 2 weeks, 37 participants with Social Anxiety Disorder (SAD) and 38 healthy controls provided reports of experiential avoidance and social anxiety symptoms during face-to-face social interactions. Results showed that momentary experiential avoidance was positively related to anxiety symptoms during social interactions and this effect was stronger among people with SAD. People low in EA showed greater sensitivity to the level of situational threat than high EA people. In the second study, we facilitated an initial encounter between strangers. Unlike Study 1, we experimentally created a social situation where there was either an opportunity for intimacy (self-disclosure conversation) or no such opportunity (small-talk conversation). Results showed that greater experiential avoidance during the self-disclosure conversation temporally preceded increases in social anxiety for the remainder of the interaction; no such effect was found in the small-talk conversation. Our findings provide insight into the association between experiential avoidance on social anxiety in laboratory and naturalistic settings, and demonstrate that the effect of EA depends upon level of social threat and opportunity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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Recent research has supported the use of mindfulness and acceptance-based interventions for Social Anxiety Disorder (SAD). The purpose of the present study was to compare mindfulness and acceptance-based group therapy (MAGT) with cognitive behavioral group therapy (CBGT) with respect to outcome. It was hypothesized that MAGT and CBGT would both be superior to a control group but not significantly different from one another. Individuals (N = 137, mean age = 34 years, 54% female, 62% White, 20% Asian) diagnosed with SAD were randomly assigned to MAGT (n = 53), CBGT (n = 53) or a waitlist control group (n = 31). The primary outcome was social anxiety symptom severity assessed at baseline, treatment midpoint, treatment completion, and 3-month follow-up. Secondary outcomes were cognitive reappraisal, mindfulness, acceptance, and rumination. Depression, valued living, and group cohesion were also assessed. As hypothesized, MAGT and CBGT were both more effective than the control group but not significantly different from one another on social anxiety reduction and most other variables assessed. The present research provides additional support for the use of mindfulness and acceptance-based treatments for SAD, and future research should examine the processes by which these treatments lead to change.
Article
Psychological need constructs have received increased attention within self-determination theory research. Unfortunately, the most widely used need-satisfaction measure, the Basic Psychological Needs Scale (BPNS; Gagné in Motiv Emot 27:199–223, 2003), has been found to be problematic (Johnston and Finney in Contemp Educ Psychol 35:280–296, 2010). In the current study, we formally describe an alternate measure, the Balanced Measure of Psychological Needs (BMPN). We explore the factor structure of student responses to both the BPNS and the BMPN, followed by an empirical comparison of the BPNS to the BMPN as predictors of relevant outcomes. For both scales, we tested a model specifying three latent need factors (autonomy, competence, and relatedness) and two latent method factors (satisfaction and dissatisfaction). By specifying and comparing a series of nested confirmatory factor analytic models, we examine the theoretical structure of the need satisfaction variables and produce evidence for convergent and discriminant validity of the posited constructs. The results of our examination suggest that the three need variables should not be combined into one general need factor and may have separate satisfaction and dissatisfaction dimensions. Our model comparisons also suggest the BMPN may be an improved instrument for SDT researchers.
Article
The personality construct of social anxiety was examined employing several methods, including the self-report subscale of the Self-Consciousness Scale, descriptions provided both by subjects and two college peers using the modified California Q-sort and direct observations of behavior recorded using the Behavioral Q-sort, of both the target subject and a randomly assigned, opposite sex interaction partner. A remarkable convergence in the content of all three types of descriptions was obtained for both male and female subjects. The socially anxious individual characterizes him/herself and is seen by his/her college peers as fearful, self-pitying and unassertive, while displaying a lack of social skills and a generally awkward interpersonal style in a series of interactions with a stranger of the opposite sex. In addition, it would appear that social anxiety has a negative effect on the behavior of the interaction partner of the socially anxious individual, thus providing support for an interpersonal cycle of social anxiety.
Article
Recent acceptance- and mindfulness-based cognitive-behavioral interventions explicitly target the clarification and commitment to a purpose in life. Yet, scant empirical evidence exists on the value of purpose as a mechanism relevant to psychopathology or well-being. The present research explored daily (within-person) fluctuations in purposeful pursuits and well-being in a community sample of 84 adults with (n = 41) and without (n = 43) the generalized subtype of social anxiety disorder (SAD). After completing an idiographic measure of purpose in life, participants monitored their effort and progress toward this purpose, along with their well-being each day. Across 2 weeks of daily reports, we found that healthy controls reported increased self-esteem, meaning in life, positive emotions, and decreased negative emotions. People with SAD experienced substantial boosts in well-being indicators on days characterized by significant effort or progress toward their life purpose. We found no evidence for the reverse direction (with well-being boosting the amount of effort or progress that people with SAD devote to their purpose), and effects could not be attributed to comorbid mood or anxiety disorders. Results provide evidence for how commitment to a purpose in life enriches the daily existence of people with SAD. The current study supports principles that underlie what many clinicians are already doing with clients for SAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Article
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Article
Multi-informant assessments of adult psychopathology often result in discrepancies among informants’ reports. Among 157 adults meeting criteria for either the generalized (n = 106) or nongeneralized (n = 51) social anxiety disorder (SAD) subtype, we examined whether discrepancies between patients’ and clinicians’ reports of patients’ symptoms related to variations in both SAD subtype and expressions of social skills deficits across multiple social interaction tasks. Latent class analyses revealed two behavioral patterns: (a) context-specific social skills deficits and (b) cross-context social skills deficits. Similarly, patients’ symptom reports could be characterized by concordance or discordance with clinicians’ reports. Patient–clinician concordance on relatively high levels of patients’ symptoms related to an increased likelihood of the patient meeting criteria for the generalized relative to nongeneralized subtype. Further, patient–clinician concordance on relatively high levels of patients’ symptoms related to an increased likelihood of consistently exhibiting social skills deficits across social interaction tasks (relative to context-specific social skills deficits). These relations were robust in accounting for patient age, clinical severity, and Axis I and II comorbidity. Further, clinical severity did not completely explain variability in patients’ behavior on laboratory tasks or discrepancies between patient and clinician reports. Findings provide the first laboratory-based support for the ability of informant discrepancies to indicate cross-contextual variability in clinical adult assessments, and the first of any developmental period to indicate this for SAD assessments. These findings have important implications for clinical assessment and developmental psychopathology research.
Article
Meaning in life is widely considered a cornerstone of human functioning, but relatively little is known about the factors that influence judgments of meaning in life. Four studies examined positive affect (PA) and social relatedness as sources of information for meaning in life judgments. Study 1 (N = 150) showed that relatedness need satisfaction (RNS) and PA each shared strong independent links to meaning in life. In Study 2 (N = 63), loneliness moderated the effects of a positive mood induction on meaning in life ratings. In Study 3 (N = 65), priming positive social relationships reduced the contribution of PA to subsequent judgments of meaning in life. In Study 4 (N = 95), relationship primes decreased reliance on PA and increased reliance on RNS compared to dessert primes. Results are discussed in terms of the value of integrating judgment processes in studies of meaning in life.
Article
Details the psychometric evaluation of the Quality of Life Inventory (QOLI), a measure of life satisfaction that may complement symptom-oriented measures of psychological functioning in evaluating the outcome of interventions aimed at ameliorating mental disorders, disabling physical illnesses, and community-wide social problems. Test–retest coefficients for the QOLI ranged from .80 to .91, and internal consistency coefficients ranged from .77 to .89 across 3 clinical and 3 nonclinical samples. QOLI item–total correlations were found to be adequate, and the QOLI had significantly positive correlations with 7 related measures of subjective well-being, including a peer rating and clinical interview measure. Significant negative correlations were obtained between the QOLI and measures of general psychopathology and depression. Clinical and nonclinical criterion groups differed significantly in mean QOLI scores. QOLI norms are presented, and the usefulness of the QOLI for assessing treatment outcome and for psychotherapy treatment planning is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Examined relations between characteristics of personal goal strivings (e.g., importance, past attainment, effort) and components of subjective well-being (positive and negative affect and life satisfaction). 40 undergraduates generated lists of their personal strivings and rated each striving on a series of dimensions. Ss also recorded their moods and thoughts by use of an experience-sampling method on 84 occasions over a 3-wk period. Positive affect was found to be most strongly related to striving value and past fulfillment, whereas negative affect was associated with low probability of future success, striving ambivalence, and between-striving conflict. Striving importance and instrumentality (low conflict) were the strongest predictors of life satisfaction. Possible explanations for the connections between striving fulfillment and positive affect and between striving conflict and negative affect are discussed. It is concluded that the concept of personal striving is a useful heuristic device for understanding individual differences in subjective well-being. The concept is proposed as an alternative to the traditional trait approach to personality. (71 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Objective: Hybrid models of psychopathology propose to combine the current categorical diagnostic system with shared symptom dimensions common across various disorders. Recently, the first empirically derived hybrid model of social anxiety was developed, including both a specific factor for the diagnostic category of social anxiety and 5 nonspecific factors for related symptoms. The present investigation developed a self-report measure-the Multidimensional Assessment of Social Anxiety (MASA)-based on this model to further the research on hybrid models. Method: This investigation included three studies across large undergraduate (N = 411; 52.3% male; mean [M] age = 19.6) and clinical (N = 684; 61.4% female; M age = 35.8) samples, involving the administration of the MASA item pool and existing measures of related constructs. Results: Through a series of psychometric evaluations, the initial 466-item pool was reduced to a final 38-item measure that represented 6 distinct scales with adequate model fit, internal consistency, test-retest reliability, and convergent and discriminant validity. Conclusions: Together, these studies likely will lead to additional research and advances in the development of the hybrid models of the mood and anxiety disorders through the dissemination and administration of the MASA.
Article
Eudaimonic theories of well-being assert the importance of achieving one’s full potential through engaging in inherently meaningful endeavors. In two daily diary studies, we assessed whether reports of engagement in behaviors representative of eudaimonic theories were associated with well-being. We also examined whether eudaimonic behaviors were more strongly related to well-being than behaviors directed toward obtaining pleasure or material goods. In both studies, eudaimonic behaviors had consistently stronger relations to well-being than hedonic behaviors. Data also provided support for a temporal sequence in which eudaimonic behaviors were related to greater well-being the next day. Overall, our results suggest that “doing good” may be an important avenue by which people create meaningful and satisfying lives.
Article
It remains unclear whether social anxiety interferes with the generation of closeness during initial encounters. We addressed the question of whether perceived closeness between strangers differs as a function of dyad characteristics (i.e., self and partner levels of social anxiety) and social context. We conducted an experiment with 90 participants randomly assigned to either a 45-minute personal disclosure or small-talk dyadic conversation. Multilevel modeling results yielded a 3-way interaction, such that the effect of social anxiety on closeness generated during the interaction was moderated by social anxiety reported by interaction partners and social context. In the personal disclosure condition, perceived closeness was greatest when the most socially anxious individuals interacted with each other. In the small-talk condition, perceived closeness was greatest when the least socially anxious individuals interacted with each other. Across conditions, partners with substantial differences in social anxiety (i.e., mixed dyads) reported relatively less closeness than partners with similar levels of social anxiety. Social anxiety effects were not attributable to depressive symptoms or physical attraction to partners. These findings suggest that neglecting specific qualities of interaction partners and social situational factors may lead to spurious conclusions in understanding interpersonal outcomes related to social anxiety.
Article
What, exactly, do individuals with social phobia fear? Whereas fear of anxiety-related bodily sensations characterizes and defines panic disorder, is there a fundamental focus of anxiety that unifies individuals under the diagnostic category of social phobia? Current conceptualizations of social phobia suggest several possible candidates, including the fear of negative evaluation, embarrassment, and loss of social status. However, it is argued here that these conceptualizations are fundamentally flawed and confusing, and the lack of clarity with respect to this question has hampered our ability to conceptualize and treat patients with social phobia in a manner that is tailored to individual differences in symptom presentation. In the present article, I will propose a novel conceptualization of core fear in social phobia, demonstrate how this conceptualization can be used to classify individuals with social phobia in a manner that eliminates confusion and accounts for symptom heterogeneity, and illustrate its potential utility for both clinical practice and research.
Article
The current study investigated the mechanism through which safety behaviors perpetuate perceived and actual negative social outcomes hypothesized to maintain social anxiety disorder (SAD). Eighty individuals diagnosed with generalized SAD took part in a "getting acquainted" conversation with a trained experimental confederate. Participants were then randomly assigned to either a safety behavior reduction plus exposure condition (SB + EXP) or a graduated exposure (EXP) control condition and completed a 2nd conversation with the same interaction partner. Mediation analyses revealed that participants instructed to reduce their idiosyncratic safety behaviors displayed significantly greater increases in both perceived and actual positive interpersonal outcomes relative to the EXP group. However, whereas the safety behavior manipulation influenced participants' appraisals of their partner's reaction to them through reducing self-judgments about the visibility of anxiety-related behaviors, in reality, the SB + EXP group elicited more positive partner reactions because they displayed a greater increase in social approach behavior. Thus, although both parties recognized positive changes in the social exchange following the safety behavior manipulation, different sources of social information accounted for participant versus partner interpersonal judgments. The current findings point to the potential value of considering both the intra and interpersonal consequences of safety behaviors in SAD.
Article
Traditionally, positive emotions and thoughts, strengths, and the satisfaction of basic psychological needs for belonging, competence, and autonomy have been seen as the cornerstones of psychological health. Without disputing their importance, these foci fail to capture many of the fluctuating, conflicting forces that are readily apparent when people navigate the environment and social world. In this paper, we review literature to offer evidence for the prominence of psychological flexibility in understanding psychological health. Thus far, the importance of psychological flexibility has been obscured by the isolation and disconnection of research conducted on this topic. Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values. In many forms of psychopathology, these flexibility processes are absent. In hopes of creating a more coherent understanding, we synthesize work in emotion regulation, mindfulness and acceptance, social and personality psychology, and neuropsychology. Basic research findings provide insight into the nature, correlates, and consequences of psychological flexibility and applied research provides details on promising interventions. Throughout, we emphasize dynamic approaches that might capture this fluid construct in the real-world.
Article
There has been significant interest in the role of anxiety sensitivity (AS) in the anxiety disorders. In this meta-analysis, we empirically evaluate differences in AS between anxiety disorders, mood disorders, and nonclinical controls. A total of 38 published studies (N = 20,146) were included in the analysis. The results yielded a large effect size indicating greater AS among anxiety disorder patients versus nonclinical controls (d = 1.61). However, this effect was maintained only for panic disorder patients compared to mood disorder patients (d = 0.85). Panic disorder was also associated with greater AS compared to other anxiety disorders except for posttraumatic stress disorder (d = 0.04). Otherwise the anxiety disorders generally did not differ from each other in AS. Although these findings suggest that AS is central to the phenomenology of panic disorder and posttraumatic stress disorder, causal inferences regarding the role of AS in these anxiety disorders cannot be made. Moderator analyses showed that a greater proportion of female participants was associated with larger differences in AS between anxiety and nonclinical control groups. However, more female participants were associated with a smaller AS difference between anxiety and mood disorder groups. This finding suggests that AS is less robust in distinguishing anxiety from mood disorders among women. Age also moderated some observed effects such that AS was more strongly associated with anxiety disorders in adults compared to children. Type of AS measure used also moderated some effects. Implications of these findings for the conceptualization of AS in anxiety-related disorders are discussed.
Article
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.