Brain response to negative comments observed in social phobia patients


Brain response to negative comments observed in social phobia patients


Patients with generalized social phobia respond with different brain imaging patterns when they make negative comments about themselves, according to a report released on October 6, 2008 in Archives of General Psychiatry, one of the JAMA/Archives journals.

Generalized social phobia generally involves fear and avoidance of social situations, paired with fear of negative judgment from others, according to the authors. They add that it is extremely prevalent: “It is the most common anxiety disorder in the general population, with the lifetime prevalence estimated at 13.3 percent, and it is associated with a high risk for depression, alcohol and drug abuse and suicide.” It has been previously shown that the brains of affected individuals respond differently to facial expressions, in results which indicate that the increased responsiveness to social stimuli may be linked to emotion.

To investigate the response of the brain to various stimuli in patients with generalized social phobia, Karina Blair, Ph.D., and colleagues at the National Institute of Mental Health, Bethesda, Md., examined functional MRI (fMRI) scans of 17 unmedicated generalized social phobia patients. These were compared to the same number of controls who were matched by age, sex, and IQ. While being scanned, the subjects read statements from various categories: "positive (e.g., You are beautiful), negative (e.g., You are ugly) and neutral (e.g., You are human) comments that could be either about the self or about somebody else (e.g., He is beautiful),” explain the authors.

When reading negative statements about themselves, brains in the patients with generalized social phobia showed increased blood flow occurred in the medial prefrontal cortex and amygdala, which are parts of the brain associated with fear, emotion, and stress response. There were no differences found between the groups in response to either negative comments referring to others or the positive comment category.

The authors conclude that these parts of the brain may be involved in social phobia. “Given that medial prefrontal cortex regions are involved in representations of the self, it might be suggested that these regions, together with the amygdala, play a primary role in the development and maintenance of generalized social phobia and that the pathology in the disorder at least partly reflects a negative attitude toward the self, particularly in response to social stimuli—that in generalized social phobia what engages the mind is others’ criticism,” they note. “This highly context-dependent response in generalized social phobia helps constrain existing models of the disorder and may thus guide future therapeutic formulations in the treatment of the disorder.”

Neural Response to Self- and Other Referential Praise and Criticism in Generalized Social Phobia

Karina Blair; Marilla Geraci; Jeffrey Devido; Daniel McCaffrey; Gang Chen; Meena Vythilingam; Pamela Ng; Nick Hollon; Matthew Jones; R. J. R. Blair; Daniel S. Pine

Arch Gen Psychiatry. 2008;65(10):1176-1184.

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Section Issues On Medicine: Psychiatry