Can social support figures enhance fear extinction in patients with social anxiety?

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Project Summary/Abstract It is estimated that roughly one third of adults in the US will be affected by a fear-related disorder over the course of their lifetime. These disorders, including diagnoses such as generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder, are marked by disruptive fears that can interfere with daily life and have harmful long-term consequences on health and well-being. Yet, even the most successful treatment to date, exposure therapy (a set of procedures that employs fear extinction processes to reduce fear) has limited effects, with discomfort during therapy leading to drop-out and relapse remaining a common occurrence. Thus, investigation of methods to augment exposure therapy treatments and improve fear reduction strategies is critical for improving the well-being of individuals with fear-related disorders. Recent work has revealed that social support may represent one such method, demonstrating that social support reminders reduce the acquisition of fear and enhance the extinction of fear in healthy adults. These findings are unexpected, as they are in direct contrast with current views that all safety signals, including social support figures, are harmful during fear-reduction interventions. Thus, while current views would suggest that these cues enhance acquisition and reduce extinction, social support reminders in fact reduce acquisition and enhance extinction. This divergence may be explained by the crucial role of social support in human survival; specifically, the neurobiological mechanisms that have evolved to reinforce social bonds appear to overlap with the systems that support fear learning, making social support uniquely poised to reduce fear. These previous findings hint at the exciting possibility that social support may play an important role in improving outcomes for individuals with fear-related disorders. In particular, the presence of social support reminders (e.g., pictures) may enrich strategies to prevent fear acquisition in individuals at risk for developing disruptive fears and augment exposure therapy treatments, enhancing extinction outcomes. However, while the fear-reducing effects of social support have been demonstrated in healthy adults, these effects have never been tested in adults with fear-related disorders. Thus, the proposed studies will be the first to explore whether social support 1) reduces fear acquisition and 2) enhances fear extinction in adults with social anxiety disorder (SAD) and healthy controls. In the first study, we will test whether the presence of a social support image (vs. smiling stranger image) reduces acquisition in participants with SAD (n=50, 25 females) and healthy controls (n=50, 25 females). In the second study, we will test whether the presence of a social support image (vs. smiling stranger image) leads to enhanced extinction in participants diagnosed with SAD (n=50, 25 females) as well as healthy controls (n=50, 25 females). This work will establish whether the fear-reducing effects of social support extend beyond healthy adults to those with fear-related disorders, potentially shedding light on simple, inexpensive ways to attenuate the formation of new fears and augment current fear reduction treatments.