Pnas: brain and behavior changes of social anxiety patients with empathic embarrassment

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Social anxiety disorders include the fear of embarrassing yourself in front of others . Jintai - Ataxia (TKS), A common subtype in East Asia , It also includes the fear of embarrassing others .TKS People are highly sensitive to the feelings of others , Fear that your physical or behavioral defects will humiliate others . To explore potential neurocognitive mechanisms , We are 23 Japanese adults compared TKS Scoring and questionnaire based empathy 、 Cognitive flexibility ( Set shift ) Brain activity related to empathy . stay 3T Functionality MRI period , The subjects watched video clips of people who sang badly , These people either show real embarrassment (EMBAR), Or show arrogant pride (PRIDE). We expect , Through emotional integration (affEMP) Emotional sharing ,EMBAR Singers will embarrass the audience , and PRIDE Singers will involve cognitive empathy (cogEMP) The choice of views embarrasses the audience . stay affEMP(EMBAR > PRIDE) period ,TKS Score and personality affEMP( Dimension of personal distress ) It is positively correlated with amygdala activity . stay cogEMP(EMBAR < PRIDE) period ,TKS Score with cognitive flexibility and posterior superior temporal sulcus / Temporoparietal junction (pSTS/TPJ) Activity is negatively correlated . The correlation analysis between subjects shows , stay affEMP period , Anterior insula 、 The involvement degree of inferior frontal gyrus and premotor cortex is higher than cogEMP, stay cogEMP period , Medial prefrontal cortex 、 Posterior cingulate cortex and pSTS/TPJ The degree of inclusion is higher than affEMP. stay cogEMP period ,TKS The higher the score , The weaker the functional connectivity of the whole brain . Observed affEMP and cogEMP The imbalance between them and the interruption of functional brain connections , It may reduce the cognitive processing ability of people who suffer from other directional social anxiety based on empathic embarrassment in embarrassing situations .
1. sketch
Social anxiety disorder (SAD) Also known as social phobia , It is one of the most common mental diseases , The lifetime prevalence rate is 15%.SAD It is characterized by avoiding social interaction due to fear of negative evaluation , For example, embarrass yourself in front of others . Jintai - Ataxia (TKS) yes SAD A subtype of , It also includes the fear of embarrassing others , for example , Because people blush 、 Sweating or shivering appearance makes them feel uncomfortable . suffer from TKS People with schizophrenia will over imagine what they look like from the perspective of others , And that their physical defects and / Or social flaws - Proper behavior will offend or humiliate others . Even though TKS Originally described as a country with a unique culture SAD Subtypes are prominent in interdependent cultures , Especially in East Asia , Similar manifestations are consistently reported in independent cultures . for example , In the U.S. ,75% Of SAD Patients show five types of fear related to other orientations TKS At least one of the symptoms .TKS Recently 《 Diagnostic and Statistical Manual of mental disorders 》 Described in the Fifth Edition . However ,TKS The brain basis and related factors of the disease are still unclear . Because the fear of being negatively evaluated by others is a sign of social anxiety , take TKS As a model of other oriented anxiety, research may add crucial insights into the mechanism of understanding the subjective experience of social anxiety .
In view of suffering from TKS Sick people's feelings about others and easy to misunderstand others' views , Let's imagine TKS Empathy with enhanced influence (affEMP; Through self - Others overlap or match to share emotions ) Enhanced perception of others' negative feelings , Or cognitive empathy decreases (cogEMP; Through self - The perspective of others ) It hinders the flexible inference of others' views and intentions different from their own . Feelings of emotional disorders may be overly attractive TKS Subject's attention , And enhanced affEMP It may further enhance the individual's response to the pain or misfortune of others . therefore ,TKS Subjects can easily turn the embarrassment of others into personal experience ( Empathic ) embarrassed , This leads to fear directed by others .
Previous studies have shown that ,affEMP By the amygdala 、 Insular and anterior cingulate cortex (ACC) Unique support for fear related activation in . contrary ,cogEMP From ventral medial prefrontal lobe and orbitofrontal cortex (vmPFC/OFC) And participate in the adoption of ideas ( Through self - Other distinctions ) Temporoparietal junction with attention diversion (TPJ) And posterior temporal sulcus (pSTS) Support . These empathy related areas may also be related to embarrassment . However , How this feeling is triggered , And turn it into other oriented social fear , Worthy of further investigation .
In order to study the neurocognitive basis of other directional social anxiety , Let's start with 23 Japanese adults TKS Level and affEMP、cogEMP Associated with cognitive flexibility scores . We also applied the Toronto Alexithymia Scale (TAS) As a measure of self-awareness and emotional change , It reflects the omen of abnormal empathy . To measure cognitive flexibility ( Notice the set shift ), We used the Wisconsin Card Sorting Test related to cognitive empathy . And then , We checked TKS Scoring and empathy related functionality MRI (fMRI) The relationship between signal strength and distribution .
stay fMRI In the process of recording , The subjects watched video clips of people who couldn't sing well , And expressed their performance , Or real embarrassment (EMBAR), Or arrogant pride (PRIDE)( chart 1). Based on previous research, empathic embarrassment can be achieved through emotion ( Bottom up ) And cognition ( From top to bottom ) Two main processes occur , We expect both singers to embarrass the audience : adopt affEMP Of EMBAR Singer and pass cogEMP Of PRIDE singer . Let's further assume that , Social anxiety subjects affEMP It will increase during observation ,cogEMP Will be reduced .

chart 1 fMRI Mission
Social anxiety may be related to changes in brain networks , But the available brain connectivity findings are inconsistent , The reason is the variability of subject characteristics ( Such as high complications and drug treatment ) Or the diversity of methods used ( for example , Use different anatomical masks ). therefore , We performed a completely data-driven segmentation analysis of whole brain function (FuSeISC), To explain the individual differences in brain activation patterns , So as to better capture the brain activity synchronized across subjects , It also shows the spatial variability between subjects in the brain network . We specifically tested TKS The relationship between score and whole brain connection strength .
2. result
The subject's TKS The rating range is 45-154, Reflect low to relatively high TKS Strength . Score and affEMP There is a statistically significant positive correlation , But with cogEMP Unrelated , It is negatively correlated with cognitive flexibility . Based on fMRI Analytical GLM In the model ,affEMP Contrast (EMBAR> PRIDE) Show , Right amygdala and ACC More activities , as well as , stay OFC, Contrary to our prediction .cogEMP contrast (PRIDE) Show the right side PST/TPJ Internal activities increase .
chart 2 Displayed on the affEMP Contrast the activity of the right amygdala with TKS The score is positively correlated , And from cogEMP The right side found in the comparison PST/TPJ( chart 2 Next ) Activity and TKS Scores are negatively correlated .ACC Activity intensity is positively correlated with alexithymia score , On the right side pSTS/TPJ Activity is positively correlated with post scan embarrassment score .

chart 2 Hemodynamic activity and TKS Score correlation
Our fully data-driven whole brain functional segmentation analysis (FuSeISC) Including calculating the correlation between subjects (ISC) Mean and variability of , To explain the differences between individuals in brain activation patterns 4. chart 3 Each shows affEMP( Upper figure ) and cogEMP( The figure below ) Of statistically significant FuSeISC Contrast figure . Please note that , The number and color of line segments in the above and below are different . stay affEMP Contrast figure ( Upper figure ) in , It showed that the brain regions involved between subjects were statistically significant, including bilateral occipital cortex ( The first 1、2 and 3 section )、 Bilateral premotor cortex ( The first 4 section , It also includes , for example , Right anterior insular 、 Inferior frontal gyrus and cerebellum )、 Superior temporal sulcus ( The first 5 paragraph , It also includes , for example , Inferior frontal gyrus and cerebellum ).
stay cogEMP Contrast figure ( chart 3 Next ) in , The affected brain areas with statistical significance include bilateral superior temporal gyrus and pSTS/TPJ(1、2、3 and 7 Segment )、 Lingual gyrus (4 and 9 Segment )、 Ventral and dorsal medial prefrontal cortex (5 Segment )、 Anterior cuneiform lobe (6 Segment ) And the intramuscular muscle (8 Segment ). These parts also include many other brain regions , Listed in SI appendix , surface S1. Please note that , We predict that mPFC The area is GLM Analytical cogEMP Invisible in comparison , But in FuSecISC It is very prominent in the analysis ( The first 5 part ), This may be due to the high variability between individuals ( chart 4).

chart 3 be based on ISC Segmentation of whole brain function
In functional connectivity analysis , Overall connectivity strength ( In from FuSeISC It is calculated from the whole brain network composed of nodes in each spatial isolation segment ) And cogEMP During the period of TKS Scores are negatively correlated , And in the affEMP period , The correlation did not reach statistical significance .

chart 4 Analysis process
3. Discuss
Our result is “ Facing others' social anxiety and enhanced affEMP And reduced cogEMP relevant ” The view of provides behavioral and brain support . stay cogEMP period , Overall network strength and TKS The negative correlation between scores supports the decline of cognitive processing ability in embarrassing situations , It may hinder the flexible inference of others' views , Divert attention or increase awkward discomfort . therefore , Our results show that , In addition to emotional and cognitive empathy imbalance ,TKS It is also characterized by the destruction of cognitive brain networks . These findings extend the current understanding of social anxiety , Proved the change affEMP and cogEMP It may be related to the social anxiety experience dominated by other oriented imaginative fear .
Previous studies on social anxiety have identified the nervous system that is believed to support fear and embarrassment , However, it is not clear whether and how these systems are attributed to anxiety of other orientations . ad locum , By using naturalistic video stimuli that induce empathic embarrassment , We reveal the behavioral and neural correlations of other directional anxiety in two key ways , indicate 1) TKS Scoring and disposability affEMP( Personal distress ) and affEMP During this period, amygdala activity is positively correlated ,2)TKS Scoring and cognitive flexibility ( Attention and perspective shift ) There is a negative correlation , And in cogEMP During the period of PST/TPJ Activities . Both results are related to the enhanced affEMP And reduced cogEMP The situation is the same in other oriented anxiety .
stay GLM and FuSeISC The analysis found that , stay cogEMP period pSTS/TPJ More than activity affEMP stronger , This is consistent with previous studies , According to the study pSTS/TPJ Serve by flexibly shifting attention and perspective cogEMP. This discovery is also consistent with the previous ISC The research is consistent , These studies emphasize PST/TPJ Role in instantaneous cognitive assessment through social attuned attention .PST/TPJ The activity is with the audience cogEMP Feel embarrassed during ( The singer can't sing well , But act as if you are proud of your singing ) The association between them also supports PST/TPJ The region better understands the situation of others in the social context .TKS Score and PST/TPJ The negative correlation between activities reflects TKS Of cogEMP Reduce , This shows that anxiety of other orientations is related to the decline of the ability to recognize embarrassment in social situations . This view is counterintuitive , Because people with social anxiety are often considered allergic to other people's feelings , Especially negative emotions towards others . However , Our view is consistent with more and more literatures , These literatures suggest that the decline of social cognition is consistent with the high social sensitivity of people with social anxiety . let me put it another way , Although socially anxious people may notice and share other people's expressions (affEMP Skill ) Pay close attention to the mental state of others , But their inferences about social situations or other people's views (cogEMP Skill ) It may be highly inaccurate .
therefore , In highly emotional situations , Elevated affEMP( Emotional sharing ) Can guide cogEMP( Point of view adoption ). Besides , Social anxiety may be related to cognitive difficulties , Especially when identifying complex emotions (47). in fact , our TKS Subjects with high scores showed enhanced affEMP And reduced cogEMP, This may amplify their attention to the feelings of others , But it hinders the flexible understanding of others' social background . therefore , These subjects were preoccupied with other directed internal fears .
be based on ISC The results of brain segmentation further support affEMP and cogEMP Its unique role in empathic embarrassment . Together with previous research , stay cogEMP During ventral and dorsal mPFC、PCC/ Precuneus and pSTS/TPJ The degree of involvement is higher than affEMP, And in the affEMP period , Anterior insula 、 Next time 、 Premotor cortex 、STS And cerebellum are more involved than aff EMP. A potential explanation for these differences is the different participation of psychologization and motor mirroring in cognitive and emotional empathy .
stay cogEMP period ,TKS The negative correlation between the score and the overall network connection strength further supports this view , That is, social anxiety in addition to emotional processing , It may also involve the interruption of cognitive processing . however , More re searches are needed , To investigate how these changes will affect yourself - Flexible distinction between other perspectives and / Or balance , Or exaggerate the negative perspective bias towards others and yourself .
We are TKS Our findings contribute to a better understanding of SAD Neurocognitive dysfunction , Because these two diseases have a common changed self - Consciousness of others .TKS and SAD Pay too much attention to the views of others . suffer from SAD Individuals are often troubled by the negative comments of others , With the improvement of self-awareness, but the experience of their own emotions is vague . meanwhile ,TKS The sick person is afraid because of his body / Behavioral characteristics make others uncomfortable . The paradigm of empathic embarrassment involves the integration and distinction between self and others , So that we can reveal that individuals who are more inclined to other oriented social anxiety may show enhanced emotional empathy and reduced cognitive empathy .TKS And self-awareness scores further support this view (SI appendix ), It emphasizes the unique self in social anxiety - Representation of others . In this regard , Our results support the proposal that social anxiety is expressed on a spectrum , The spectrum includes different clinical manifestations from mild to severe and even broader social anxiety continuum extending to the general population , Thus affecting a lot of interpersonal interaction .
4. Conclusion
Our findings show that , stay TKS Other oriented social tranquility studied in patients , It is characterized by an imbalance of empathy ( Enhanced affEMP And reduced cogEMP) as well as cogEMP The destruction of brain networks . In an embarrassing situation , These abnormalities may worsen cognitive processes . Our results reveal how changes in emotional and cognitive processing contribute to the development of social fear .
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