Social Anxiety Disorder (SAD) and the Negative Processing of Positive Facial Expressions

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Summary

The fundamental skill of being able to process facial expressions is crucial in being able to socialise within everyday life. One clinical disorder which is often linked with atypical facial processing is social anxiety disorder (SAD). The majority of previous research investigates a link between SAD and a hypersensitivity to negative expressions. However, there is a lack of research exclusively looking at the way individuals with SAD process positive expressions. It could be hypothesised that individuals with SAD process positive expressions in a negative way, leading to an impairment in positive facial processing. Funding this experiment would help add additional evidence to the existing literature about how the atypical processing in SAD may not be solely linked with negative stimuli. Evidence from the funding would help develop further knowledge about the disorder, while also being able to expand treatment programmes, such as cognitive behavioural therapy (CBT).

This study aims to investigate the way individuals with SAD process positive facial stimuli. Each participant will complete the Social Interaction Anxiety Scale (SIAS) (Mattick & Clarke, 1998) and then take part in a functional magnetic resonance imaging (MRI) scan. While undergoing an fMRI scan, they will perform a facial expression task. This task will only focus on the responses to positive faces. Results will show whether there are any differences in brain activity between SAD processing and a control group.

Scientific summary

Even though there is a lot of research giving priority to negative association to negative facial expressions within SAD, there is a lack of research specifically focusing on the way individuals with SAD process positive expressions. Previous research has shown that when individuals with anxiety focus on negative expressions there is an increased activation in the amygdala and insula, as well as the prefrontal cortex. The current study aims to determine whether there is a difference in activated regions, when processing positive facial expressions, compared to negative expressions. Participants will complete the SIAS on a 5-point scale before undergoing an MRI scan while taking part in a facial processing task. The fMRI will detect any increases in blood oxygen levels while the participant carries out the facial processing task.

Results of the fMRI will show the blood oxygen level dependent response (BOLD) which will display the neural activity while the participant was carrying out the cognitive task. Each participant’s BOLD response will then be compared to see if there are any significant similarities within neural activity and their SIAS rating. Funding this research will show if there is any atypical processing in the way an individual with anxiety processes positive facial expressions. Funding of this kind would be beneficial to clinical settings to aid therapy practices. Supporting such research is vital to improving the well-being of SAD individuals, but it is also valuable for the individual’s family, friends, relationships and even wider connections such as their working community.

Case for Support

The importance of emotional facial processing has been researched widely. Emotional facial expressions are demonstrated to be a vital source of valuable information for individuals. This emphasis on the importance of emotional facial expressions dates all the way back to Darwin. He posed that facial expressions are an innate and widespread element of non-verbal communication (Darwin, 1872). This has been evident in the amount of research that has been done on facial expressions, suggesting they provide information about thoughts, emotions and intentions of others. These in turn can influence the viewers perception of them, as well as their preceding intentions and actions (Seidel, Habel, Kirschner, Gur, & Derntl, 2010). Individuals who have an impairment within emotional facial processing often have difficulties in social interactions.

One model of psychiatric disorder argues that an impairment in facial processing may in fact be one of the factors that initiates and maintains the disorder instead of it being a symptom (Harmer, Goodwin, & Cowen, 2009). This means that a deficit in facial processing might be a core element within psychiatric disorders, instead of just being a casual symptom within the disorder. The model by Harmer, Goodwin & Cowen (2009) suggests that atypical emotional facial processing can result in distorted negative behaviours. They argue that this distorted view of facial processing subsequently leads to a sequence of negative social behaviour. Thus, allowing them to stress the importance of understanding the neural processes of such individuals in order to determine the aetiology of any psychiatric disorder. As well as, being crucial basis for developing strategic treatment plans.

Atypical emotional facial processing is thought to be a key feature of some clinical and neuropsychological disorders. For example, some individuals with prosopagnosia which is a deficit in face recognition, demonstrate that their deficit results in a constant source of social stress. Another psychiatric disorder believed to be affected by an impairment in emotional facial processing is SAD. A common hypothesis of SAD is that an individual with social anxiety will process a facial expression in a biased way to make it appear more threatening. Lots of present research has put emphasis on the way individuals process negative facial expressions and posing a hypersensitivity within negative processing. However, The American Psychiatric Association (APA) define social anxiety disorder as “a persistent fear of one or more social situations where embarrassment may occur and the fear of anxiety is out of proportion to the actual threat posed by the social situation as determined by the persons cultural norms” (APA, 2000). Despite the APA definition of SAD having no exclusive emphasis on SAD being associated with negative expressions, the majority of present research does. Much of the current literature emphasises this association, it leads to an disregarded concern about how SAD individuals interpret and process positive facial stimuli.

Anxiety disorders are highly common within the general population and are often related to stress, which can overall have an impact on an individual’s quality of life (Barrera & Norton, 2009). A common aspect of individuals with SAD is the inability to trust others (Cooper, et al., 2014), which could be down to the way they process facial expressions. In other words, an individual with SAD may take someone’s facial expression of warmth and kindness, as being negative and dishonest. It has been expressed that as a self-protection mechanism socially, anxious individuals often create a biased means of unambiguous facial expressions as untrustworthy and negative (Heimberg, Brozovich, & Rapee, 2014). This is often as a result of a deficit in the ability of processing emotional expressions.

Within cognitive neuroscience, it has been evident that symptoms of anxiety disorders are thought to be as a result of an imbalance of activity within the emotional regions of the brain. In a study by Evans et al. (2008), they found that perception of negative faces (including angry and harsh faces) by individuals with social anxiety led to a greater activation in the amygdala, insula and dorsal anterior cingulate cortex (ACC). For funding this type of research an MRI scan is pivotal, as it can address the associations between the neural activity and the cognitive task. It involves putting together an overall image of the different, most activated parts of the brain, while carrying out the facial expression task. This is important as it allows us to see the transformation from the baseline periods of the brain, where it is in a relative normal state, all the way to when it is performing the task.

Plan for investigation

A total of twenty participants will be recruited for the experiment, who have good to excellent vision. Ten of those recruited will have SAD, while the other ten participants will act as a control group. Once participants have given their consent, all participants will complete the SIAS, and be briefed about the MRI procedure. The whole experiment should last about 60-100 minutes. After this they will all receive the task instructions. This will entail how they will receive a face of a positive expression on a screen within the MRI scanner. The images will be presented individually and centrally on the screen in a randomised order to reduce any order effects. By the means of a key press, participants’ task is to quickly and accurately identify if a positive emotion is being presented. Each image remains on the screen until a response was detected or a 4 second elapse. Experimental trials were preceded by two practice trials. An eye tracker will also be in place during the experiment to make sure participants are not distracted and are concentrating on the task. The MRI scan will show which parts of the brain are needing more oxygen for their activity by their BOLD response which is measured by an fMRI. The findings from the MRI will be displayed on a probability map whereby the brain is divided into a number of voxels. Then an fMRI software will be used to determine the BOLD response for each voxel.

Ethical considerations

As the participants are taking part in an MRI scan, they will need to be free of any MRI contradictions. This includes anyone whom may be pregnant or is pregnant, as specialists are unsure of the implications of an MRI scan on the foetus. Also, individuals with tattoos need to be excluded as some tattoos include small fragments of metal for pigmentation. There are also other cautions with wigs, insulin pump, pacemakers, epilepsy etc. To make sure participants are free of any contradictions they will be asked about them before taking part. All healthy controls will have no medical, neurological, or psychiatric disorder history. This will help reduce any inconsistencies in brain activity between the control and experimental group. In addition, all participants will be free of any head injuries, frequent drug, cigarette or alcohol use, to help attain accurate brain activity results.

Another ethical consideration is that many claustrophobic individuals cannot stand the confined space of the MRI bore. This may be a key problem for SAD participants as it may bring on a panic attack. To help minimise participants anxiety while in the bore, they will be told to raise their hand at any time they wish to terminate or pause the experiment. There will also be a neck brace in place to help ensure participants feel secure and at ease. The brace will also help reduce peripheral muscle or nerve stimulation which may feel like a twitching sensation caused by the noise of the magnetic field within the MRI. In addition to the neck brace, participants will be given adequate ear protection to protect them from the loud noises that the magnetic fields produce. A quick questionnaire about how participants are feeling before and after the scan will be conducted to help prevent and measure any psychological stress, so the right help can be provided if required.

As any procedure, an MRI scan may have side effects to the participant. The information sheet and the debrief, will advise participants to seek help from their general practitioner if believed to be having side effects. Carrying out such precautions like these should help provide a reliable and valid study. Funding this study will therefore provide results which can be utilised and be benefited by the wider society.

Expected outcomes and impact

As stated previously, findings from the fMRI software will determine the BOLD response for each voxel, following each radio pulse. An increased signal would result in more oxygen being present in that region. Thus, highlighting an increase in neural activity within that area of the brain. Such findings will help demonstrate any increased activation in areas of the brain which may be alternative to the control group. In addition to this, the different scores on the SIAS and activated brain regions could be compared to determine any differences and correlations. Once results have been obtained, further work can be done to compare the current findings to previous findings such as Evans et al. (2008). This will reveal if there are any differences in the way SAD individuals process negative and positive expressions in respect to their neural activity.

However, further work would be needed to interpret results accurately. One expected outcome will be that SAD individuals have atypical processing of positive facial stimuli, which will be demonstrated through irregular neural activity. From funding this research, findings would therefore help explain how individuals with anxiety often interpret positive as well as negative facial expressions in an atypical way. Such results may allow clinical settings to tailor their therapy in a way to help the individual change their processing pathway of positive expressions. This in turn may help reduce such symptoms of anxiety or their power over the individual. Finally resulting in coercive treatment plans for anxiety sufferers being available.

The impact of such funding doesn’t only help individuals with SAD, but also helps society as a whole. While, obviously improving the well-being of SAD individuals, it may also elp them become more socially active. This may encourage them to apply for jobs which would help reduce rates of unemployment. Thus, becoming beneficial to the economy. Aiding their well-being also involves improving individual’s mental health who suffer from SAD. From this, the rate of suicide, self-harm and other self-reduction methods may be reduced, making the individual a more positive person.

References

Barrera, T. L., & Norton, P. J. (2009). Quality of life impairment in generalised anxiety disorder, social phobia, and panic disorder. Journal of Anxiety Disorders, 23, 1086-1090.
Cooper, R., Doehrmann, O., Fang, A., Gerlack, A. L., Hoijtink, H. J., & Hofmann, S. G. (2014). Relationship between social anxiety and percieved trustworthiness. Jornal of Anxiety, Stress and Coping, 27, 190-201.
Darwin, C. (1872). The expression of the emotions in man and the animals. London: John Murray.
Evans, K. C., Wright, C. L., Wedig, M. M., Gold, A. L., Pollack, M. H., & Rauch, S. L. (2008). A functional MRI study of amygdala responses to angry schematic faces in social anxiety disorder. Depression and Anxiety, 25, 496-505.
Harmer, C. J., Goodwin, G. M., & Cowen, P. J. (2009). Why do antidepressants take so long to work? A cognitive neuropsychological model of antidepressants drug action. British Journal of Psychiatry(195), 102-108.
Heimberg, R. C., Brozovich, F. A., & Rapee, R. M. (2014). A cognitive-behavioural model of social anxiety disorder. Social anxiety: Clinical, developmental and social perspectives, 3, 705-728.
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Journal of Behaviour Research and Therapy, 36, 455-470.
Seidel, E. M., Habel, U., Kirschner, M., Gur, R. C., & Derntl, B. (2010). The impact of facial emotional expressions on behavioural tendencies in women and men. Journal of Experimental Psychology on Human Perception and Performance, 36, 500-507.

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