Mood and Anxiety Disorders Program, National Institute of Mental Health, 15K North Dr, MSC 2670, Bethesda, MD 20892, USA.
J Clin Psychiatry. 2011 Jul;72(7):942-8. doi: 10.4088/JCP.09m05731blu. Epub 2010 Oct 5.
A detailed understanding of how individuals diagnosed with social anxiety disorder (SAD) respond physiologically under social-evaluative threat is lacking. Our aim was to isolate the specific components of public speaking that trigger fear in vulnerable individuals and best discriminate between SAD and healthy individuals.
Sixteen individuals diagnosed with SAD (DSM-IV-TR criteria) and 16 healthy individuals were enrolled in the study from December 2005 to March 2008. Subjects were asked to prepare and deliver a short speech in a virtual reality (VR) environment. The VR environment simulated standing center stage before a live audience and allowed us to gradually introduce social cues during speech anticipation. Startle eye-blink responses were elicited periodically by white noise bursts presented during anticipation, speech delivery, and recovery in VR, as well as outside VR during an initial habituation phase, and startle reactivity was measured by electromyography. Subjects rated their distress at 4 timepoints in VR using a 0-10 scale, with anchors being "not distressed" to "highly distressed." State anxiety was measured before and after VR with the Spielberger State-Trait Anxiety Inventory.
Individuals with SAD reported greater distress and state anxiety than healthy individuals across the entire procedure (P values < .005). Analyses of startle reactivity revealed a robust group difference during speech anticipation in VR, specifically as audience members directed their eye gaze and turned their attention toward participants (P < .05, Bonferroni-corrected).
The VR environment is sufficiently realistic to provoke fear and anxiety in individuals highly vulnerable to socially threatening situations. Individuals with SAD showed potentiated startle, indicative of a strong phasic fear response, specifically when they perceived themselves as occupying the focus of others' attention as speech time approached. Potentiated startle under social-evaluative threat indexes SAD-related fear of negative evaluation.
个体在社会评价性威胁下的生理反应机制尚未明晰，本研究旨在深入了解社交焦虑障碍（SAD）患者的这一反应。我们旨在确定引发易患个体恐惧的具体演讲内容，并对 SAD 患者与健康个体进行最佳区分。
2005 年 12 月至 2008 年 3 月期间，共有 16 名 SAD 患者（DSM-IV-TR 标准）和 16 名健康个体纳入本研究。研究对象被要求在虚拟现实（VR）环境中准备并发表一段简短演讲。VR 环境模拟站在舞台中央，面对真实观众，使我们能够在演讲前逐步引入社会线索。在 VR 环境中，通过在演讲前、演讲中和恢复期呈现白噪声刺激，定期诱发惊跳眨眼反应，同时在初始习惯化阶段，在 VR 之外通过眼动电图进行惊跳反应测量。研究对象在 VR 中通过 0-10 分制对 4 个时间点的不适程度进行评分，其中“不难受”到“高度难受”。在 VR 前后使用 Spielberger 状态-特质焦虑量表对状态焦虑进行测量。
与健康个体相比，SAD 患者在整个过程中报告了更大的不适和状态焦虑（P 值均<.005）。惊跳反应分析显示，VR 环境中，在演讲前阶段，当观众将目光和注意力转向参与者时，出现了明显的群体差异（P<.05，Bonferroni 校正）。
VR 环境足以引发对高度易受社交威胁情境的恐惧和焦虑。SAD 患者的惊跳反射增强，提示存在强烈的相位恐惧反应，特别是当他们意识到自己在演讲临近时成为他人关注的焦点时。在社会评价性威胁下增强的惊跳反射反映了 SAD 患者对负面评价的恐惧。
