Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

doi:10.1016/j.pscychresns.2018.12.017

Randomized Controlled Trial

. 2019 Feb 28:284:13-20.

doi: 10.1016/j.pscychresns.2018.12.017. Epub 2019 Jan 2.

Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Affiliations

¹ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N Philadelphia, PA 19104, USA. Electronic address: lilybr@upenn.edu.
² Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Social, Genetic and Development Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK. Electronic address: katherine.s.young@kcl.ac.uk.
³ Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street Suite 4202, Sacramento, CA 95817, USA. Electronic address: pgoldin@ucdavis.edu.
⁴ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: jtorre@psych.ucla.edu.
⁵ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; NeuroGen Technologies, Inc., P.O. Box 775 Burbank, CA 91505, USA. Electronic address: burklund@ucla.edu.
⁶ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: cdavies@psych.ucla.edu.
⁷ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: aniles@ucla.edu.
⁸ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: lieber@ucla.edu.
⁹ Department of Psychology, University of Southern California, 3620 South McClintock Avenue, Los Angeles, CA 90089, USA. Electronic address: dsaxbe@usc.edu.
¹⁰ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: craske@psych.ucla.edu.

PMID: 30622047
PMCID: PMC6415528
DOI: 10.1016/j.pscychresns.2018.12.017

Randomized Controlled Trial

Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Lily A Brown et al. Psychiatry Res Neuroimaging. 2019.

. 2019 Feb 28:284:13-20.

doi: 10.1016/j.pscychresns.2018.12.017. Epub 2019 Jan 2.

Authors

Affiliations

¹ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N Philadelphia, PA 19104, USA. Electronic address: lilybr@upenn.edu.
² Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; Social, Genetic and Development Psychiatry (SGDP) Centre, Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK. Electronic address: katherine.s.young@kcl.ac.uk.
³ Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street Suite 4202, Sacramento, CA 95817, USA. Electronic address: pgoldin@ucdavis.edu.
⁴ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: jtorre@psych.ucla.edu.
⁵ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA; NeuroGen Technologies, Inc., P.O. Box 775 Burbank, CA 91505, USA. Electronic address: burklund@ucla.edu.
⁶ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: cdavies@psych.ucla.edu.
⁷ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: aniles@ucla.edu.
⁸ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: lieber@ucla.edu.
⁹ Department of Psychology, University of Southern California, 3620 South McClintock Avenue, Los Angeles, CA 90089, USA. Electronic address: dsaxbe@usc.edu.
¹⁰ Department of Psychology, University of California, Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA. Electronic address: craske@psych.ucla.edu.

PMID: 30622047
PMCID: PMC6415528
DOI: 10.1016/j.pscychresns.2018.12.017

Abstract

Self-referential processing is critical to understanding social anxiety disorder (SAD). This study examined neural differences in self-referential processing in healthy controls (HC) and participants with SAD at pre- and post-treatment. Participants (n = 64) underwent fMRI scanning while viewing a video of themselves ("Self") or another person ("Other"). SAD participants were randomized to cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT), or waitlist, and were re-scanned at post-treatment. In SAD vs. HC, the fusiform face area (FFA) showed significantly more activation during Self vs. Other, and greater SAD severity was associated with significantly more activation during Self vs. Other in the right FFA and the left extrastriate body area (EBA). Greater reduction in SAD severity was associated with stronger connectivity between the amygdala and FFA during Self vs. Other at post-treatment, whereas the strength of connectivity during Self and Other was comparable at post-treatment for those with less SAD reduction. Thus, there were significant differences in activation and functional connectivity of brain regions implicated in self-referential processing in SAD. Change in connectivity between the amygdala and FFA were observed as a function of change in SAD severity, suggesting that improvements in SAD severity may correct this altered functional connectivity.

Keywords: Acceptance and commitment therapy; Cognitive behavior therapy; Self-referential processing; Social anxiety disorder.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Drs. Craske, Brown, Lieberman, Young and Goldin reported receiving funding from the National Institute of Health. Dr. Brown reported receiving funding from the Department of Defense.

Figures

**Figure 1.**
Pre-treatment correlation between social anxiety severity (LSAS) and fusiform face area (FFA) and extrastriate body area (EBA) activation Note. Panel A depicts neural activation when the LSAS was entered as a regressor. Panel B depicts the association between the right FFA for Self – Other correlated with LSAS. Panel C depicts the association between the left EBA for Self – Other correlated with LSAS.

**Figure 2.**
Pre-treatment functional connectivity with the right amygdala as a seed region for the socially anxious (SAD) and healthy control (HC) groups Note: Panel A depicts the functional connectivity between right amygdala and right insula differences for SAD vs. HC. Panel B depicts the right amygdala and right insula connectivity strength for Self – Other for SAD and HC.

**Figure 3.**
Pre- to post-treatment left insula activation during self- versus other-referential processing in the treatment and waitlist groups

**Figure 4.**
Right amygdala to ventromedial prefrontal cortex (VMPFC) connectivity

See this image and copyright information in PMC

Cited by

Modulation of the Endocannabinoid and Oxytocinergic Systems as a Potential Treatment Approach for Social Anxiety Disorder.
Dos Santos RG, de Lima Osório F, Martin-Santos R, Zuardi AW, Hallak JEC, Crippa JAS. Dos Santos RG, et al. CNS Drugs. 2019 Oct;33(10):1031-1038. doi: 10.1007/s40263-019-00669-5. CNS Drugs. 2019. PMID: 31617149 Review.
Neural circuit basis of pathological anxiety.
Akiki TJ, Jubeir J, Bertrand C, Tozzi L, Williams LM. Akiki TJ, et al. Nat Rev Neurosci. 2025 Jan;26(1):5-22. doi: 10.1038/s41583-024-00880-4. Epub 2024 Nov 27. Nat Rev Neurosci. 2025. PMID: 39604513 Review.
Corticotropin-Releasing Factor receptor 1 (CRF1) antagonism in patients with alcohol use disorder and high anxiety levels: effect on neural response during Trier Social Stress Test video feedback.
Lee MR, Rio D, Kwako L, George DT, Heilig M, Momenan R. Lee MR, et al. Neuropsychopharmacology. 2023 Apr;48(5):816-820. doi: 10.1038/s41386-022-01521-z. Epub 2022 Dec 23. Neuropsychopharmacology. 2023. PMID: 36564531 Free PMC article. Clinical Trial.
A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders.
Haller H, Breilmann P, Schröter M, Dobos G, Cramer H. Haller H, et al. Sci Rep. 2021 Oct 14;11(1):20385. doi: 10.1038/s41598-021-99882-w. Sci Rep. 2021. PMID: 34650179 Free PMC article.
Neural Mechanisms of Cognitive Behavioral Therapy Efficacy in Anxiety Disorders: A Scoping Review of fMRI-Based Studies That Tested the Dual Model.
Domínguez-Pérez J, Peñate-Castro W, Rivero-Pérez FL. Domínguez-Pérez J, et al. Life (Basel). 2025 Mar 18;15(3):493. doi: 10.3390/life15030493. Life (Basel). 2025. PMID: 40141837 Free PMC article. Review.

See all "Cited by" articles

References

1. Abraham A, Kaufmann C, Redlich R, Hermann A, Stark R, Stevens S, et al., (2013). Self-referential and anxiety-relevant information processing in subclinical social anxiety: an fMRI study. Brain Imaging Behav, 7, 35–48, DOI: 10.1007/s11682-012-9188-x. - DOI - PubMed
1. American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing, Arlington, VA.
1. Blair K, Geraci M, Devido J, McCaffrey D, Chen G, Vythilingam M, et al., (2008). Neural response to self- and other referential praise and criticism in generalized social phobia. JAMA Psychiatry. 65, 1178–1184. doi:10.1001/archpsyc.65.10.1176 - DOI - PMC - PubMed
1. Brühl AB, Delsignore A, Komossa K, Weidt S, 2014. Neuroimaging in social anxiety disorder – A meta-analytic review resulting in a new neurofunctional model. Neurosci. Biobehav. Rev, 47, 260–280. doi: 10.1016/j.neubiorev.2014.08.003 - DOI - PubMed
1. Burklund LJ, Craske MG, Taylor SE, Lieberman MD, 2015. Altered emotion regulation capacity in social phobia as a function of comorbidity. Soc Cogn Affect Neurosci, 10:199–208. doi: 10.1093/scan/nsu058. - DOI - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

R21 MH081299/MH/NIMH NIH HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Abraham A, Kaufmann C, Redlich R, Hermann A, Stark R, Stevens S, et al., (2013). Self-referential and anxiety-relevant information processing in subclinical social anxiety: an fMRI study. Brain Imaging Behav, 7, 35–48, DOI: 10.1007/s11682-012-9188-x. - DOI - PubMed

[2] Abraham A, Kaufmann C, Redlich R, Hermann A, Stark R, Stevens S, et al., (2013). Self-referential and anxiety-relevant information processing in subclinical social anxiety: an fMRI study. Brain Imaging Behav, 7, 35–48, DOI: 10.1007/s11682-012-9188-x. - DOI - PubMed

[3] American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing, Arlington, VA.

[4] American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing, Arlington, VA.

[5] Blair K, Geraci M, Devido J, McCaffrey D, Chen G, Vythilingam M, et al., (2008). Neural response to self- and other referential praise and criticism in generalized social phobia. JAMA Psychiatry. 65, 1178–1184. doi:10.1001/archpsyc.65.10.1176 - DOI - PMC - PubMed

[6] Blair K, Geraci M, Devido J, McCaffrey D, Chen G, Vythilingam M, et al., (2008). Neural response to self- and other referential praise and criticism in generalized social phobia. JAMA Psychiatry. 65, 1178–1184. doi:10.1001/archpsyc.65.10.1176 - DOI - PMC - PubMed

[7] Brühl AB, Delsignore A, Komossa K, Weidt S, 2014. Neuroimaging in social anxiety disorder – A meta-analytic review resulting in a new neurofunctional model. Neurosci. Biobehav. Rev, 47, 260–280. doi: 10.1016/j.neubiorev.2014.08.003 - DOI - PubMed

[8] Brühl AB, Delsignore A, Komossa K, Weidt S, 2014. Neuroimaging in social anxiety disorder – A meta-analytic review resulting in a new neurofunctional model. Neurosci. Biobehav. Rev, 47, 260–280. doi: 10.1016/j.neubiorev.2014.08.003 - DOI - PubMed

[9] Burklund LJ, Craske MG, Taylor SE, Lieberman MD, 2015. Altered emotion regulation capacity in social phobia as a function of comorbidity. Soc Cogn Affect Neurosci, 10:199–208. doi: 10.1093/scan/nsu058. - DOI - PMC - PubMed

[10] Burklund LJ, Craske MG, Taylor SE, Lieberman MD, 2015. Altered emotion regulation capacity in social phobia as a function of comorbidity. Soc Cogn Affect Neurosci, 10:199–208. doi: 10.1093/scan/nsu058. - DOI - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Affiliations

Self-referential processing during observation of a speech performance task in social anxiety disorder from pre- to post-treatment: Evidence of disrupted neural activation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical