Department of Psychiatry, Columbia University, New York, NY, USA.
New York State Psychiatric Institute, New York, NY, USA.
J Psychiatr Res. 2021 Nov;143:155-162. doi: 10.1016/j.jpsychires.2021.09.022. Epub 2021 Sep 2.
Social anxiety disorder (SAD) is associated with fear of negative evaluation and heightened performance monitoring. The best-established treatments help only a subset of patients, and there are no well-established predictors of treatment response. The current study investigated whether individual differences in processing errors might predict response to gaze-contingent music reward therapy (GC-MRT). At baseline, healthy control subjects (HC; n = 20) and adults with SAD (n = 29), ages 19-43 years, completed the Flanker Task while electroencephalography (EEG) data were recorded. SAD participants then received up to 12 sessions over 8 weeks of GC-MRT, designed to train participants' attention away from threatening and toward neutral faces. Clinical assessments were completed 9- (post-treatment) and 20-weeks (follow-up) after initiating the treatment. At baseline, compared to HC, SAD performed the task more accurately and exhibited increased error-related negativity (ERN) and delta power to error commission. After controlling for age and baseline symptoms, more negative ERN and increased frontal midline theta (FMT) predicted reduced self-reported social anxiety symptoms at post-treatment, and FMT also predicted clinician-rated and self-reported symptom reduction at the follow-up assessment. Hypervigilance to error is characteristic of SAD and warrants further research as a predictor of treatment response for GC-MRT.
社交焦虑障碍（SAD）与对负面评价的恐惧和表现监测增强有关。最成熟的治疗方法仅对一部分患者有效，而且对于治疗反应也没有既定的预测指标。本研究调查了处理错误的个体差异是否可以预测注视相关音乐奖励治疗（GC-MRT）的反应。在基线时，健康对照组（HC；n=20）和社交焦虑障碍患者（SAD；n=29）年龄在 19-43 岁之间，完成了 Flanker 任务，同时记录了脑电图（EEG）数据。然后，SAD 参与者在 8 周内接受了多达 12 次 GC-MRT 治疗，旨在训练参与者将注意力从威胁转移到中性面孔上。临床评估在开始治疗后 9-（治疗后）和 20 周（随访）进行。在基线时，与 HC 相比，SAD 完成任务的准确性更高，表现出更高的错误相关负波（ERN）和错误时的 delta 功率。在控制年龄和基线症状后，更负的 ERN 和增加的额中线 theta（FMT）预示着治疗后自我报告的社交焦虑症状减少，而 FMT 也预示着临床医生评定和自我报告的症状减少在随访评估中。对错误的过度警惕是 SAD 的特征，值得进一步研究，作为 GC-MRT 治疗反应的预测指标。
