Neural mechanisms of cognitive reappraisal of negative self-beliefs in social anxiety disorder

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Figure 1

Components and structure of one autobiographical social situation trial.

Figure 2

Negative emotion intensity ratings for Neutral Statements, React Negative Self-Beliefs, and Reappraise Negative Self-Beliefs in patients with social anxiety disorder and healthy controls. Negative emotion ratings after the offset of each stimulus were provided by participants in response to “How negative do you feel?” (1=not at all, 2=slightly, 3=moderately, and 4=very much, 5=extreme). * P<.001; error bars = standard error of the mean.

Figure 3

Left dorsal amygdala BOLD signal time series for (A) healthy controls during reactivity and reappraisal and (B) patients with SAD during reactivity and reappraisal. Left dorsal amygdala was thresholded at voxel-wise P<.001 and cluster volume>162 mm³ to protect against false positive cluster detection at cluster-wise P<.005. Left dorsal amygdala early versus late contrast in HC (peak BOLD signal=.25; Talairach coordinates= −18, −3, −10; cluster volume= 733 mm³) and in SAD (peak BOLD signal=.20; Talairach coordinates=−17 −5, −10; 570 mm³). The overlapping ROI mask included both peaks and had a volume of 529 mm³. * P<.05, ** P<.01

Figure 4

Early cognitive reappraisal-related brain responses in patients with SAD versus healthy controls. RED = HC > SAD Early cognitive reappraisal of negative self-beliefs. 1=medial PFC, 2=dorsolateral PFC, 3=dorsal anterior cingulate cortex, 4=precuneus, 5=inferior parietal lobule. Between-group t-test, t>2.93, voxel P<.005, cluster volume>162; cluster P<.01