Brain mediators of biased social learning of self-perception in social anxiety disorder

Social anxiety disorder (SAD) is characterized by an excessive fear of social evaluation and a persistently negative view of the self. Here we test the hypothesis that negative biases in brain responses and in social learning of self-related information contribute to the negative self-image and low self-esteem characteristic of SAD. Adult participants diagnosed with social anxiety (N = 21) and matched controls (N = 23) rated their performance and received social feedback following a stressful public speaking task. We investigated how positive versus negative social feedback altered self-evaluation and state self-esteem and used functional Magnetic Resonance Imaging (fMRI) to characterize brain responses to positive versus negative feedback. Compared to controls, participants with SAD updated their self-evaluation and state self-esteem significantly more based on negative compared to positive social feedback. Responses in the frontoparietal network correlated with and mirrored these behavioral effects, with greater responses to positive than negative feedback in non-anxious controls but not in participants with SAD. Responses to social feedback in the anterior insula and other areas mediated the effects of negative versus positive feedback on changes in self-evaluation. In non-anxious participants, frontoparietal brain areas may contribute to a positive social learning bias. In SAD, frontoparietal areas are less recruited overall and less attuned to positive feedback, possibly reflecting differences in attention allocation and cognitive regulation. More negatively biased brain responses and social learning could contribute to maintaining a negative self-image in SAD and other internalizing disorders, thereby offering important new targets for interventions.

Those who passed the pre-screening were then interviewed by trained research assistants using the MINI for DSM-5 as well as the Social Anxiety Module of the ADIS-5 by phone to determine final study eligibility.To be included in the MRI study, participants had to be right-handed, between 18-40y old, have normal or corrected-to-normal vision, be able to read and write comfortably in English, own a personal smartphone with internet and texting capabilities (due to an experience-sampling procedure during eight days prior to the brain imaging part of the study, as reported elsewhere 17 ), not have any neurological conditions or contra-indications for MRI scanning (e.g., pregnancy, metal implants, claustrophobia, pacemaker, cochlear implant, tattoos on head or neck, older tattoos with metalcontaining inks, non-removable metal piercings, implanted infusion pump devices…).

General procedures.
Prior to the task of interest in the current study, participants were scanned while completing a resting state task and a prospection task (findings to be reported elsewhere).They were then told that they had 4 minutes during which they should mentally prepare a 3-min speech on the topic: "Why would you be a good candidate for your ideal job?".Participants were further told that judges would listen to their speech and will later give them feedback on their speech.To increase believability of the speech task and feedback procedure, the participants were briefly introduced to one of the judges in a lab coat in the scanner room before entering the scanner.However, unbeknownst to the participants, the judges (confederates) did not actually evaluate the performance, and only one, female judge was in the control room (in addition to the experimenter and scanner operators).The other (male) judge was introduced based on a replayed voice recording which was piloted to be indistinguishable from a person present at the scan.One of the judges prompted the participant to start the speech.
If the participant stopped talking for more than 20 seconds at any point, the judge reminded them to keep talking by saying "Please continue".After 3 minutes, one of the judges informed participants the speech task had ended.Following a brief questionnaire, participants then performed the two runs of the feedback task described in the Methods of the paper.

Feedback task.
For each trial within the T1 feedback task, participants: 1) first rated themselves on their speech (self-evaluation), 2) then received the judges' feedback (while their own rating remained on screen, thus revealing the mismatch between their own rating and the judges' feedback), and 3) rated their current self-esteem.
Approximately half of the trials had a positive and half of the trials had a negative feedback mismatch (ΔEval, the difference between the judges' feedback and participants' self-evaluation), with absolute values ranging from 0.17-0.44(on the VAS scale from 0-1).On trials in which the judges' feedback would have been beyond the scale limits (smaller than 0 or greater than 1, which occurred when the participant rated themselves particularly low or high), the judges' feedback was replaced with a random value between the limit and the participants' self-evaluation.
Table S2.Evaluative statements used in the social feedback task.During the initial presentation of the statement and during the self-evaluative rating phase, the statements were preceded by "I" (e.g., "I was organized").During the presentation of the judges' feedback, the statements were preceded by "She" or "He" (e.g., "She was organized" or "He was organized").The presentation order of statements was randomized for each subject.Reverse-coded items are marked with (-).
Figure S3.Results of the funneled debriefing questionnaire.From left to right, HC (blue) and SAD (red) participants' ratings on a visual analog scale (VAS, higher values reflect more agreement with statement) in 1) experience in public speaking, 2) perception that the feedback accurately described their performance, 3) belief that they would actually have to give a speech, 4) belief that they would be judged, and 5) belief that the feedback was real.Participants had a substantial range of experience with giving oral presentations (mean rating and standard deviation on a VAS from 0-5, M(STD) = 2.93(1.23)).Most of them described the feedback as rather accurate in describing their performance, M(STD) = 3.39(0.81).Regarding the oral debriefing questions, participants showed substantial variation but overall believed that they had to give a speech, M(STD) = 3.22(1.49),that they would be judged, M(STD) = 3.09(1.41),and that the feedback given was real, M(STD) = 3.07(1.21).Notably, from the oral debriefing it appeared that even those participants who had doubts about the feedback said they were affected by it, in line with previous results demonstrating that even hypothetical social feedback affects mood and brain responses 18 .Most importantly, none of the debriefing items differed significantly between HC and SAD groups (all p's > 0.26) and most of them (except 'Experience with public speaking') had almost identical mean values.Thus, any differences in behavior or brain responses between groups could not be explained by measurable differences in how much HC and SAD groups believed in the authenticity of the judges and the feedback.

Figure S5 .
Figure S5.Correlation between positive-negative bias in social influence effects on self-perception with positive-negative bias in affective updating.HC are shown as blue diamonds, SAD participants as red circles.