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OBJECTIVE:
Somatic marker theory predicts that somatic cues serve intuitive decision making; however, cardiovascular symptoms are threat cues for patients with panic disorder (PD). Therefore, enhanced cardiac perception may aid intuitive decision making only in healthy individuals, but impair intuitive decision making in PD patients.
METHODS:
PD patients and age-and sex-matched volunteers without a psychiatric diagnosis (n=17, respectively) completed the Iowa Gambling Task (IGT) as a measure of intuitive decision making. Interindividual differences in cardiac perception were assessed with a common mental-tracking task.
RESULTS:
In line with our hypothesis, we found a pattern of opposing associations (Fisher's Z=1.78, P=0.04) of high cardiac perception with improved IGT-performance in matched control-participants (r=0.36, n=14) but impaired IGT-performance in PD patients (r=-0.38, n=13).
CONCLUSION:
Interoceptive skills, typically assumed to aid intuitive decision making, can have the opposite effect in PD patients who experience interoceptive cues as threatening, and tend to avoid them. This may explain why PD patients frequently have problems with decision making in everyday life. Screening of cardiac perception may help identifying patients who benefit from specifically tailored interventions.
Mediators of Social Anxiety - External Social Threat-Cues vs. Self-Related Negative Cognitions
(2009)
Based on a review of models and empirical findings a working model is proposed, suggesting that self-related negative cognitions and biased processing of external social threat-cues are mediators of social anxiety. Hypotheses derived from this model were tested in three experiments. The first experiment examined whether levels of trait social anxiousness predicted fearful responding to external social threat-cues (angry vs. neutral and happy facial expressions) during social evaluation. Higher trait social anxiousness predisposes to an inward focus on one’s fear reaction to social threat. Using this strategy was expected to enhance fearful responding to angry facial expressions. A strategy of identifying with angry faces was expected to counteract fearful responding, but was expected to fail more often with increasing levels of trait social anxiousness. To examine these hypotheses, affective modulation of the startle eye-blink was assessed in forty-four undergraduate students. This measure served as a probe into the activation of brain structures involved in the automatic evaluation of environmental threat-cues. Trait and state anxiety as well as explicit emotional responding to the stimuli were assessed with questionnaires and ratings. Processing angry faces potentiated startle amplitudes as expected. Low arousal induced by the stimuli was a probable reason, why startle potentiation to happy faces emerged instead of attenuation. Trait social anxiousness and the cognitive strategies did not influence these effects. Yet, increased trait social anxiousness predicted decreased startle latency, indicating motor hyper-responsivity, which is part of the clinical representation of social anxiety disorder (SAD). Processing facial expressions and identifying with them disrupted this association. Previous studies support that similar strategies may enhance treatment of SAD. Individuals with SAD were expected to respond with increased arousal to external social threat-cues. Therefore, the second experiment examined whether nine individuals with SAD showed attentional (prepulse inhibition, PPI) or affective startle modulation to angry as compared to neutral and happy facial expressions. Corrugator supercilii activity was assessed as a behavioral indicator for effects of facial expressions. The remaining setup resembled the first experiment. Facial expressions did not modulate the startle reflex, but corrugator supercilii activity was sensitive to facial valence. However, the effects were not related to trait social anxiousness. Apparently, angry facial expressions do not act as phobic stimuli for individuals with SAD. The third experiment examined whether focusing on self-related negative cognitions or biased processing of external social threat-cues mediates relationships between trait social anxiety and anxious responding in a socially challenging situation. Inducing self-related negative cognitions vs. relaxation was expected to reveal a functional dependency on the supposed mediation in a multivariate assessment of criteria of the working model. Within this design, the impact of external social threat-cues (facial expressions and emotional words) was compared to control stimuli and context effects, using the startle paradigm. The findings provide first evidence for full statistical mediation of the associations between trait social anxiety and self-reported anxiety as well as parasympathetic withdrawal by self-related negative cognitions, when thirty-six undergraduate students anticipated public speaking. Apprehensive arousal, as indicated by increased skin conductance levels and heart rate, was present in all participants. Observer ratings of behavior during public speaking matched the self-rated quality of the performance. None of these measures were correlated with trait social anxiousness. Startle amplitude correlated with state and trait social anxiety, but was no mediator. Finally, there was no affective modulation of the startle amplitude by external social threat-cues. These studies advance both our current understanding of the factors that mediate social anxiety responses to situations and our knowledge of the physiological and anatomical mechanisms involved in social anxiety. Based on these findings a revised version of the working model on mediators of social anxiety is proposed in the hope it may aid further research for the ultimate goal of developing an empirically validated functional anatomical model of social anxiety.