Intrusive re-experiencing in social anxiety disorder: Does context matter?

社交焦虑症（SAD）的一个重要特征是对负面评价的明显恐惧。在社会情境中扭曲的负面自我形象是一个重要的维持因素。这些图像的内容和意义似乎与发生在社交焦虑发作或明显加重时的令人厌恶的社交经历（例如戏弄）有关。这些扭曲的图像类似于创伤后应激障碍（PTSD）中创伤事件后的侵入性再体验。最近的研究表明，SAD患者确实具有对厌恶性社会事件的侵入性重新体验的特征。条件性恐惧的功能失调性消退被认为是侵入性再体验发展和维持的机制。据推测，PTSD患者不能使用上下文信息，以充分调节条件性恐惧，可能与创伤事件的时空背景和自传体记忆的整合不足。海马体及其对杏仁核的直接和间接投射在条件性恐惧的情境依赖性调制中起着关键作用。先前的研究表明，改变的消退过程以及海马异常特征SAD类似于PTSD。然而，它是未知的，如果困难的上下文歧视和上下文调制灭绝也相关的SAD。在一项功能和结构磁共振成像研究中，将在55名SAD患者和55名健康对照者中研究背景依赖性消退过程的神经相关性。预计SAD患者将表现出对疾病相关事件的增强的侵入性再体验。此外，SAD患者的特征应是在基本的上下文歧视的赤字，以及减少上下文调制的皮肤电条件反射期间灭绝。这些情境处理缺陷应该进一步与侵入性再体验的量相关联。在神经层面上，这应该反映在海马体的激活减少以及它与恐惧和灭绝回路的进一步结构的连接改变上。本研究的结果可能有助于确定在SAD的条件性恐惧的背景下，以及优化长期的治疗干预措施的相关性，在campal-dependent的上下文歧视和上下文调制的赤字。

A crucial characteristic of social anxiety disorder (SAD) is the pronounced fear of negative evaluation. Distorted negative images of the self in social situations are an important maintenance factor. Content and meaning of these images seem to be related to aversive social experiences (e.g. teasing) that occurred around the onset or a marked aggravation of social anxiety. These distorted images resemble intrusive re-experiencing following traumatic events in posttraumatic stress disorder (PTSD). Recent studies show that patients with SAD are indeed characterized by intrusive re-experiencing in response to aversive social events. Dysfunctional extinction of conditioned fear is supposed to be the mechanism underlying the development and maintenance of intrusive re-experiencing. It is assumed that PTSD patients are not able to use contextual information in order to adequately regulate conditioned fear, probably related to an insufficient integration of the traumatic event into the spatio-temporal context and the autobiographical memory. The hippocampus with its direct and indirect projections to the amygdala plays a key role in context-dependent modulation of conditioned fear. Previous studies show that altered extinction processes as well as hippocampal abnormalities characterize SAD similar to PTSD. However, it is unknown if difficulties in context discrimination and contextual modulation of extinction are also of relevance for SAD. In a functional and structural magnetic resonance imaging study, the neural correlates of context-dependent extinction processes will be investigated in 55 patients with SAD and 55 healthy controls. It is expected that patients with SAD will show enhanced intrusive re-experiencing in response to disorder-relevant events. Furthermore, SAD patients should be characterized by deficits in basic context discrimination as well as a reduced contextual modulation of electrodermal conditioned responses during extinction. These contextual processing deficits should further be associated with the amount of intrusive re-experiencing. On the neural level, this should be reflected in diminished activation of the hippocampus as well as its altered connectivity with further structures of the fear and extinction circuit. The results of this study might contribute to determine the relevance of deficits in hippocampal-dependent contextual discrimination and contextual modulation of conditioned fear in SAD as well as to optimize therapeutic interventions in the long-term.