How Brain Imaging Helps Explain Social Anxiety Disorder

Some People With SAD Respond Better to CBT Than Others

If you've received cognitive-behavioral therapy (CBT) and/or medication for social anxiety disorder, it is likely that the choice of treatment was based on the perspective of the professional who administered it, more so than characteristics of you as a patient.

That could all change, with research investigating the usefulness of "neuromarkers" in predicting which patients will respond better to certain types of treatments. These areas of the brain are identified during scans known as functional magnetic resonance imaging (fMRI).

In a 2013 study led by John D. Gabrieli out of the Massachusetts Institute of Technology, and supported by the National Institute of Mental Health (NIMH), it was found that among 39 patients with SAD who received 12 weeks of CBT, those who more strongly reacted to angry faces (based on looking at their brain scans) showed better improvement.

This means that it may be possible to identify individuals who are more likely to respond better to CBT for social anxiety disorder.

Meditation Can Help Those With SAD

In a 2009 study led by Stanford research Philippe Goldin, and published in the Journal of Cognitive Psychotherapy, it was found that 9 sessions (2 months) of mindfulness-based stress reduction (meditation directed at focusing on bodily sensations) resulted in improvements in views of the self among those with social anxiety disorder.

Individuals who with SAD who completed the MBSR program also showed improved ability to shift their thinking and focus, in particular away from the negative and toward the positive.

Based on the brain imaging conducted in the study, it appeared that brain activity in areas related to visual attention also increased.

However, the increase in visual attention seen in this study indicated that people were "staying with the stimulus rather than running away," according to Goldin.

This research shows that meditation, and in particular MBSR, may be helpful in improving symptoms of social anxiety, particularly related to negative self-views and selective visual attention.

Exercise Can Help Those With SAD

The human brain naturally produces a variety of chemicals including dopamine (reward), serotonin (relaxation) and endorphins (pain relief).

In a 2009 brain-imaging study led by Charles Hillman and published in the journal Neuroscience, it was found that walking improved the cognitive control of attention in preadolescent children.

The data from the study support moderate acute exercise for increasing attention and academic performance; however, there is other research on the effects of exercise on the brain that could perhaps have relevance for SAD.

Endorphins released during exercise may help to improve various brain systems necessary to overcome social anxiety disorder. For example, endorphins released during exercise may help with neurogenesis or new brain growth. Although speculative, this could lead to increased capacities, such as better clarity of thinking and an improved view of the outside world. Exercise may also stimulate better attention, which we already know (see Goldin's study above) may be important for those who tend to look away in social situations.

Therefore, the brain scans above showing the difference in brain activity with or without exercise suggests a positive benefit of exercise for those with SAD.

Social Anxiety and Introversion Are Different

A simple example of how brain imaging can help untangle social anxiety disorder may come from work on introversion versus extroversion. While introversion and social anxiety are not the same things (introverts become overstimulated by social interaction while those with social anxiety have a fear response), understanding how brain pathways differ for different types of personalities can still be helpful.

In a 2005 fMRI study led by Michael Cohen and published in the journal Cognitive Brain Research, it was found that extroverts responded more strongly when a gamble paid off. It is argued that this is a result of differences in the reward pathways in the brains of extroverts (those who crave external stimulation).

Similarly, Hans Eysenck argued back in the 1960s that introverts naturally have a higher basic level of arousal compared to extroverts.

All of this centers on the notion that extroverts process stimuli through a shorter brain pathway that involves taste, touch, vision, and audition, while introverts use a longer pathway involving memory, planning, and problem-solving.

How does this relate to SAD? The introversion/extroversion dimension seems to relate to different brain processes at a structural level; therefore, it would seem these would be hard to change. On the other hand, we know the social anxiety can improve through treatment. This just emphasizes the notion that SAD and introversion, though often confused, are not the same thing.

Social Anxiety May Be Hereditary

In a 2015 paper published in Proceedings of the National Academy of Sciences of the United States of America and led by Ned Kalin of the University of Wisconsin-Madison, it was shown that the functioning of certain areas of the brain may be related to a genetic predisposition toward an anxious temperament.

The study looked at 600 rhesus monkeys from a large multi-generational family. Using a task in which the young monkeys were faced with a threat (a stranger who did not look at them), the researchers employed high-resolution functional and structural brain imaging.

What they found was that there was overactivity in three brain areas (the prefrontal-limbic-midbrain circuit) among anxious young monkeys.

They also determined that 35% of the variation in anxiety tendency was explained by family history.

Interestingly, the three areas of the brain that were implicated are survival-related: the brain stem (primitive brain), amygdala (fear center), and prefrontal cortex (high-level reasoning).

This study tells us that anxiety may have been genetically passed down because it held evolutionary value—that of avoiding danger.