Seinsche Rosa J, Fricke Susanne, Neudert Marie K, Zehtner Raphaela I, Walter Bertram, Stark Rudolf, Hermann Andrea
Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Germany; Bender Institute of Neuroimaging, Justus Liebig University Giessen, Germany.
Bender Institute of Neuroimaging, Justus Liebig University Giessen, Germany; Center for Mind, Brain and Behavior, Phillips University Marburg and Justus Liebig University Giessen, Germany.
J Anxiety Disord. 2023 Mar;94:102669. doi: 10.1016/j.janxdis.2023.102669. Epub 2023 Jan 16.
Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.
厌恶性社交经历被认为是罹患社交焦虑障碍（SAD）的一个风险因素。许多SAD患者报告有相关的日常生活症状，比如反复不由自主地重新体验（例如，对自己的负面扭曲形象）、回避、认知和情绪改变，以及过度警觉，类似于创伤后应激障碍（PTSD）的症状维度。这些类PTSD症状可能源于对厌恶性社交经历在记忆中的适应不良处理和表征。在以往研究中发现，在对厌恶性社交经历的记忆检索过程中的情绪过度反应是SAD的另一个特征。本研究旨在进一步调查与病因相关的厌恶性社交经历相关的类PTSD症状和情绪反应，并进一步阐明两者之间的潜在关系。85名SAD患者和85名健康对照（HC）参与了这项横断面研究。它包括一项想象任务，采用自我报告和生理测量来评估在提示性回忆厌恶性社交经历期间的情绪反应，以及临床访谈来评估类PTSD症状。我们预期，与HC相比，SAD患者在面对厌恶性社交经历时情绪反应会增强，类PTSD症状会更严重，并且SAD患者的情绪反应与类PTSD症状之间存在正相关。事实上，SAD患者在提示性回忆厌恶性社交经历期间表现出情绪过度反应（自我报告、生理方面），与两种对照记忆条件（中性、负面非社交）以及HC相比也是如此。此外，与HC相比，SAD患者报告的类PTSD症状更严重，并且在SAD患者中，反复不由自主地重新体验症状与社交厌恶性事件想象期间的痛苦呈正相关。这些结果可能指向厌恶性社交经历在记忆中的适应不良表征。与PTSD类似，这种适应不良的记忆表征可能会促进类PTSD症状的发展，比如反复不由自主地重新体验（例如，以SAD患者脑海中不由自主出现的自我形象的形式），这最终可能导致并维持SAD症状。
