Clinical psychology

BackgroundPrevious research has demonstrated that the cerebellum is involved in emotive and cognitive processes. Furthermore, recent findings suggest high-frequency repetitive transcranial magnetic stimulation (rTMS) to the cerebellum has mood-improving properties. We sought to further explore the effects of cerebellar high-frequency rTMS on implicit processing of emotional stimuli and mood.MethodsIn a double-blind, crossover study, 15 healthy volunteers received 15 minutes of 20 Hz (5 s on, 5 s off) rTMS over the medial cerebellum, occipital cortex or sham in a randomized counterbalanced order on 3 consecutive days. A masked emotional faces response task measured implicit emotional processing of happy, fearful and neutral facial expressions. We used positive and negative affect scales to evaluate rTMS-related changes in mood.ResultsHigh-frequency rTMS over the cerebellum was associated with significant increases in masked emotional responses to happy facial expressions only. We observed no changes in consciously experienced mood.LimitationsAlthough the sham rTMS served as our baseline measurement, additional pre-rTMS data showing that reaction time increases immediately after cerebellar rTMS would have made our results more compelling.ConclusionThe results replicate and extend previous findings by establishing a direct relation between the cerebellum and emotive information-processing. The parallel between the present effects of high-frequency cerebellar rTMS and short-term antidepressant therapy regarding the change in implicit processing of positive stimuli in the absence of mood changes is notable and warrants further research.

Testosterone is an important regulator of social–motivational behavior and is known for its dominance-enhancing and social-anxiolytic properties. However, to date no studies have systematically investigated the causal effect of testosterone on actual social approach–avoidance behavior in humans. The present study sets out to test the effects of testosterone administration in healthy female volunteers using an objective implicit measure of social motivational behavior: the social Approach–Avoidance Task, a reaction time task requiring participants to approach or avoid visually presented emotional (happy, angry, and neutral) faces. Participants showed significantly diminished avoidance tendencies to angry faces after testosterone administration. Testosterone did not affect approach–avoidance tendencies to social affiliation (happy) faces. Thus, a single dose testosterone administration reduces automatic avoidance of social threat and promotes relative increase of threat approach tendencies in healthy females. These findings further the understanding of the neuroendocrine regulation of social motivational behavior and may have direct treatment implications for social anxiety, characterized by persistent social avoidance.

Gaze avoidance is one of the most characteristic and persistent social features in people with Social Anxiety Disorder (SAD). It signals social submissiveness and hampers adequate social interactions. Patients with SAD typically show reduced testosterone levels, a hormone that facilitates socially dominant gaze behavior. Therefore we tested as a proof of principle whether single dose testosterone administration can reduce gaze avoidance in SAD. In a double-blind, within-subject design, 18 medication-free female participants with SAD and 19 female healthy control participants received a single dose of 0.5 mg testos-terone and a matched placebo, at two separate days. On each day, their spontaneous gaze behavior was recorded using eye-tracking, while they looked at angry, happy, and neutral facial expressions. Testos-terone enhanced the percentage of first fixations to the eye-region in participants with SAD compared to healthy controls. In addition, SAD patients' initial gaze avoidance in the placebo condition was associated with more severe social anxiety symptoms and this relation was no longer present after testosterone administration. These findings indicate that single dose testosterone administration can alleviate gaze avoidance in SAD. They support theories on the dominance enhancing effects of testosterone and extend those by showing that effects are particularly strong in individuals featured by socially submissive behavior. The finding that this core characteristic of SAD can be directly influenced by single dose testosterone administration calls for future inquiry into the clinical utility of testosterone in the treatment of SAD.

Testosterone enhances amygdala reactions to social threat, but it remains unclear whether this neuroendocrine mechanism is relevant for understanding its dominance-enhancing properties; namely, whether testosterone biases the human amygdala toward threat approach. This pharmacological functional magnetic-resonance imaging study shows that testosterone administration increases amygdala responses in healthy women during threat approach and decreases it during threat avoidance. These findings support and extend motivational salience models by offering a neuroendocrine mechanism of motivation-specific amygdala tuning.

People derive their sense of belonging from perceptions of being a moral person. Research moreover suggests that social cues of rejection rapidly influence visual scanning, and result in avoidant gaze behavior, especially in socially anxious individuals. With the current eye-tracking experiment, we therefore examined whether moral integrity threats and affirmations influence selective avoidance of social threat, and how this varies with individual differences in social anxiety. Fifty-nine participants retrieved a memory of a past immoral, moral, or neutral act. Next, participants passively viewed angry, happy, and neutral faces, while we recorded how often they first fixated on the eyes. In addition, we administered the Liebowitz Social Anxiety Scale (1987). Participants first fixated less on angry eyes compared to happy or neutral eyes when their moral integrity was threatened, and this selective avoidance was enhanced with increasing social anxiety. Following a moral affirmation, however, participants no longer selectively avoided the eyes of angry faces, regardless of individual differences in social anxiety. The results thus suggest that both low and high socially anxious people adjust their social gaze behavior in response to threats and affirmations of their moral integrity, pointing to the importance of the social context when considering affective processing biases.

Persistent fear and avoidance in patients with social anxiety disorder (SAD) has been associated with reduced testosterone levels. Because threat avoidance is a major maintaining factor in SAD, and because testosterone administration promotes social approach, we tested whether testosterone administration can directly facilitate threat approach behavior in SAD. In a double-blind, placebo-controlled study, 17 female participants with SAD received a single dose of testosterone before performing a well-established social Approach-Avoidance Task. This objective implicit measure of social motivational action tendencies requires participants to approach or avoid visually presented emotional faces. After testosterone administration, the patients showed increased approach tendencies to angry facial expressions. These results suggest that testosterone can counteract persistent automatic social avoidance tendencies in SAD. This finding advances our understanding of steroid involvement in the regulation of social motivational action in general and in SAD in particular, and may have important clinical implications, promoting testosterone’s candidacy for pharmacological treatment-enhancement studies.

The objective of the present longitudinal study was to examine the relationship between cognitive coping strategies and depressive symptoms at old age. At the two and a half year follow-up study, a community sample of 99 people aged 67 years and older filled out a self-report questionnaire comprising the Geriatric Depression Scale, the Cognitive Emotion Regulation Questionnaire and a negative life events checklist. Cognitive coping strategies seemed to play an important role in relation to depressive symptoms in late life. Elderly persons with more depressive symptoms reported to use acceptance, rumination and catastrophizing to a significantly higher extent and positive reappraisal to a significantly lower extent than those with lower depression scores. After controlling for negative life events and prior depressive symptoms, acceptance and positive reappraisal retained their significant relationship with current depressive symptoms. It is suggested that intervention programs should pay attention to these aspects by challenging the 'maladaptive' strategies, and by supplying the more 'adaptive' strategies. This could be linked to the well-established cognitive therapies.

The objective of the present study was to examine the joint effects of stress, coping, and coping resources in predicting depressive symptoms. A community sample comprising 194 people aged 65 and older was interviewed. Task-oriented coping and emotion-oriented coping both appeared to be directly related to depressive symptoms. In addition, emotion-oriented coping moderated the impact of stress to varying degrees, depending on the amount of stress experienced. Coping resources (social support and coping self-efficacy) also were directly related to depressive symptoms. Furthermore, coping self-efficacy appeared to be related to the kind of coping strategies used. Respondents with higher coping self-efficacy used more task-oriented coping and less emotion-oriented coping. These findings suggest that it is advisable to include coping resources when studying stress-coping processes. Developing prevention and intervention programs aimed at teaching people adaptive coping strategies and helping them to build up their coping resources seems advisable.