Excitatory Dorsal Lateral Prefrontal Cortex Transcranial Magnetic Stimulation Increases Social Anxiety

Abstract

Social exclusion refers to the experience of rejection by one or more people during a social event and can induce pain-related sensations. Cyberball, a computer program, is one of the most common tools for analyzing social exclusion. Regions of the brain that underlie social pain include networks linked to the dorsal lateral prefrontal cortex (DLPFC). Specifically, self-directed negative socially induced exclusion is associated with changes in DLPFC activity. Direct manipulation of this area may provide a better understanding of how the DLPFC can influence the perception of social exclusion and determine a causal role of the DLPFC. Transcranial magnetic stimulation (TMS) was applied to both the left and right DLPFC to gauge different reactions to the Cyberball experience. It was found that there were elevated exclusion indices following right DLPFC rTMS; participants consistently felt more excluded when the right DLPFC was excited. This may relate to greater feelings of social pain when the right DLPFC is manipulated. These data demonstrate that direct manipulation of the DLPFC results in changes in responses to social exclusion.

Keywords: Cyberball; DLPFC; TMS; pain; rTMS; social exclusion; social pain.

Figure 1

Overall procedure. Participants first played a brief game of Cyberball where they were socially excluded (A). Following the game (B), participants received TMS 5 times, in random order. Following each TMS session, the participants completed the reflective and reflexive Surveys (C).

Figure 2

Reflective slider responses based on reaction time. This figure shows the relationship between the various reaction times and slider responses. There is a trend that shows quicker reaction times may attribute to higher scores regarding exclusion. Each color in Figure 2 represents a participant and corresponds with the same participant and color in Figure 3.

Figure 3

Reflexive slider responses based on reaction time. This figure shows the relationship between the various reaction times and slider responses. There is a trend that shows quicker reaction times may attribute to higher scores regarding exclusion, which is similar to Figure 1. Each color in Figure 2 represents a participant and corresponds with the same participant and color in Figure 1.

Figure 4

Reflexive uncertainty. This figure shows the average slider responses based on the region where TMS was performed. Higher scores correlated with more feelings of uncertainty. The significance between 10 Hz Right and 1 Hz Left is p = 0.046, whereas the significance between 1 Hz Left and 1 Hz Right is p = 0.017. Error bars display standard error, and all other comparisons are non-significant. * p < 0.05.

Figure 5

Reflexive self-esteem scale slider responses. The relationship between each area is shown based on a post-hoc test. The significant differences are for 10 Hz Right and 1 Hz Left. Standard error is plotted, and no other relationship is significant. Error bars display standard error, and all other comparisons are non-significant. * p < 0.05.

Figure 6

Reflexive control scale slider responses. This figure shows the relationship between the slider responses when asked about control over the game. There are significant differences in the 10 Hz Right and 1 Hz Right regions, p = 0.04. Standard error is plotted, and no other significant findings were reported. * p < 0.05.