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.
Key Words
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Article info
Publication history
Published online: September 01, 2009
Accepted:
July 10,
2009
Received in revised form:
June 19,
2009
Received:
April 14,
2009
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
