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Learning from other people's fear: amygdala-based social reference learning in social anxiety disorder

Published online by Cambridge University Press:  01 August 2016

K. S. Blair ,
M. Otero ,
C. Teng ,
M. Geraci ,
E. Lewis ,
N. Hollon ,
R. J. R. Blair ,
Monique Ernst ,
C. Grillon  and
D. S. Pine
K. S. Blair*
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
M. Otero
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
C. Teng
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
M. Geraci
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
E. Lewis
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
N. Hollon
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
R. J. R. Blair
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
Monique Ernst
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
C. Grillon
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
D. S. Pine
Affiliation:
Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
*
*Address for correspondence: K. S. Blair, Ph.D., Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 15K North Drive, Room 115A, MSC 2670, Bethesda, MD 20892-2670, USA. (Email: peschark@mail.nih.gov)
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Abstract

Background

Social anxiety disorder involves fear of social objects or situations. Social referencing may play an important role in the acquisition of this fear and could be a key determinant in future biomarkers and treatment pathways. However, the neural underpinnings mediating such learning in social anxiety are unknown. Using event-related functional magnetic resonance imaging, we examined social reference learning in social anxiety disorder. Specifically, would patients with the disorder show increased amygdala activity during social reference learning, and further, following social reference learning, show particularly increased response to objects associated with other people's negative reactions?

Method

A total of 32 unmedicated patients with social anxiety disorder and 22 age-, intelligence quotient- and gender-matched healthy individuals responded to objects that had become associated with others’ fearful, angry, happy or neutral reactions.

Results

During the social reference learning phase, a significant group × social context interaction revealed that, relative to the comparison group, the social anxiety group showed a significantly greater response in the amygdala, as well as rostral, dorsomedial and lateral frontal and parietal cortices during the social, relative to non-social, referencing trials. In addition, during the object test phase, relative to the comparison group, the social anxiety group showed increased bilateral amygdala activation to objects associated with others’ fearful reactions, and a trend towards decreased amygdala activation to objects associated with others’ happy and neutral reactions.

Conclusions

These results suggest perturbed observational learning in social anxiety disorder. In addition, they further implicate the amygdala and dorsomedial prefrontal cortex in the disorder, and underscore their importance in future biomarker developments.

Keywords

Amygdalaemotionsimagingmedial prefrontal cortexsocial anxiety
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 14 , October 2016 , pp. 2943 - 2953
Copyright
Copyright © Cambridge University Press 2016 

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