Emotion Regulation in Social Anxiety Disorder: Reappraisal and Acceptance of Negative Self-beliefs

Background: Social anxiety disorder (SAD) is characterized by negative self-beliefs (NSBs) that are thought to maintain symptom severity-at least in part-by impairing emotion regulation. Few studies to date have investigated the neural basis of emotion regulation during NSBs in SAD. Moreover, different regulation strategies have not been directly compared, leaving open questions about the generality of emotion regulation deficits in SAD.

Methods: Patients with SAD (n = 113) and healthy control subjects (n = 35) underwent functional magnetic resonance imaging while reacting to NSBs or attempting to downregulate negative emotions occasioned by NSBs using either reappraisal (reinterpreting negative beliefs) or acceptance (nonjudgmentally experiencing thoughts and emotions). Ratings of negative emotion were collected after each trial.

Results: When cued to do so, patients with SAD were able to downregulate negative emotions using both reappraisal and acceptance and demonstrated effective recruitment of frontoparietal regulatory regions. Patients with SAD demonstrated greater activation of default mode network and somatomotor regions for the react versus accept contrast. Both groups demonstrated reductions in frontoparietal and default mode network activation during acceptance relative to reappraisal. Greater SAD symptom severity was associated with lower activation in frontoparietal regions during both regulation conditions.

Conclusions: There were no group differences in frontoparietal recruitment during two distinct emotion regulation strategies. However, individual differences in symptom severity within the SAD group were associated with frontoparietal regulation-related activation. Patients with SAD were differentiated from control subjects in default mode network recruitment patterns, suggesting that acceptance may be a useful task condition for revealing altered neural activity in SAD.