Social anxiety disorder is a mental health condition characterized by intense and persistent fear or anxiety of social situations. The individual is afraid of being scrutinized, judged, or embarrassed. People with this disorder tend to experience excessive self-consciousness and may avoid social interactions or situations to prevent feelings of discomfort or humiliation. The emotional distress they feel may be accompanied by physical symptoms such as rapid heartbeat, sweating, trembling, and blushing.
Individuals who suffer from social anxiety disorder experience the fear of being negatively evaluated by others. It is a core cognitive symptom of this disorder. However, more recent research indicates that individual suffering from this disorder fear not only negative but also positive evaluation. Unlike the fear of negative evaluation, which is a symptom of other disorders as well, the fear of positive evaluation is a symptom that is unique to social anxiety disorder. In spite of this, it has been the focus of very few studies compared to the fear of negative evaluation.
Study author Yifei Zhang and his colleagues wanted to test the relationships between fear of negative evaluation, fear of positive evaluation, and symptoms of social anxiety disorder over time in young adults. They hypothesized that fears of positive and negative evaluation at an earlier time would predict the later extent of social anxiety disorder symptoms. They also wanted to detect patterns of neural activity that are specific for social anxiety disorder.
To this end, they analyzed data from a large research project that combined functional magnetic resonance imaging and psychological assessments. Participants were college students. Of the sample, 869 of them completed psychological assessments and 692 completed functional magnetic resonance imaging scans. Participants completed assessments of social anxiety (the Social Interaction Anxiety Scale and the Social Phobia Scale), fear of negative evaluation (the Brief Fear of Negative Evaluation Scale), and fear of positive evaluation (the Fear of Positive Evaluation Scale).
The results indicated that fear of negative evaluation, fear of positive evaluation, and social anxiety disorder all tended to be relatively stable over time. Individuals who feared positive or negative evaluation more or had higher social anxiety at the first data collection time point also tended to have higher values at the second data collection time point and vice versa.
Both fear of positive and fear of negative evaluation at an earlier time point predicted social anxiety disorder symptoms at later timepoints. Fear of negative evaluation at an earlier time point did not predict fear of positive evaluation at later time points. However, individuals who had more pronounced social anxiety disorder symptoms at an earlier time point tended to have higher fear of positive evaluation later.
An analysis of neuroimaging data showed that participants with higher levels of fear of negative evaluation tended to have less intense zero-filled amplitude of low-frequency fluctuations (zfALFF) signals in the left dorsolateral prefrontal cortex region of the brain. High zfALFF values in a specific brain region suggest increased spontaneous neural activity and functional connectivity in that area.
Individuals with more pronounced fear of positive evaluation tended to have stronger zfALFF signals in two clusters of the ventromedial prefrontal cortex. Finally, individuals with more pronounced social anxiety disorder symptoms tended to have stronger zfALFF signals in the right ventromedial prefrontal cortex region of the brain.
“Results demonstrated that both fear of negative evaluation and fear of positive evaluation could predict social anxiety disorder symptoms independently and that social anxiety disorder symptoms falloff could also predict subsequent fear of positive evaluation,” the researchers wrote, adding that “the dorsolateral prefrontal cortex signals were negatively associated with fear of negative evaluation, whereas the ventromedial prefrontal cortex signals were positively related to fear of positive evaluation and social anxiety disorder.”
“Finally, a brain-behavior model was built to integrate fALFF results and the BFOE [bivalent fear of evaluation] model [a theoretical model proposing that fears of positive and negative evaluation are distinct factors]. It revealed that abnormal prefrontal cortex signals influenced social anxiety disorder symptoms via fears of evaluation,” the study authors concluded.
The study sheds light on the neural underpinnings of social anxiety. However, it also has limitations that need to be considered. Notably, all participants were college students. Results on other age and social groups might not be the same. Additionally, zero-filled amplitude of low-frequency fluctuations signals they relied on only indicates the intensity of local neuronal activity with no other details.
The study, “From fears of evaluation to social anxiety: The longitudinal relationships and neural basis in healthy young adults”, was authored by Yifei Zhang, Junwen Chenb, Wei Gaoa, Wanting Chena, Zhibing Xiaoa, Yawei Qi, Ofir Turel, and Qinghua He.
