Empathy Modulates the Effects of Acute Stress on Anxious Appearance and Social Behavior in Social Anxiety Disorder.

Patients suffering from social anxiety disorder (SAD) fear social interaction and evaluation, which severely undermines their everyday life. There is evidence of increased prosocial behavior after acute social stress exposure in healthy individuals, which may be interpreted as stress-regulating "tend-and-befriend" behavior. In a randomized controlled trial, we measured empathic abilities in a first diagnostic session. In the following experimental session, we investigated how patients with SAD (n = 60) and healthy control participants (HC) (n = 52) respond to an acute social stressor (Trier Social Stress Test for groups) or a non-stressful control condition, and whether empathic abilities and acute social stress interact to modulate anxious appearance and social behavior in a social conversation test. Salivary cortisol, heart rate, and subjective stress response were repeatedly measured. The anxious appearance and social behavior of participants were rated by the conversation partner. SAD patients demonstrated stronger subjective stress responses while the biological responses did not differ from HC. Moreover, patients performed worse overall in the conversation task, which stress additionally undermined. Finally, we found that both emotional and cognitive empathy buffered the negative effects of acute stress on social behavior in SAD, but not in HC. Our data highlight the importance of empathic abilities for SAD during stressful situations and call for multimodal clinical diagnostics. This may help to differentiate clinical subtypes and offer better-tailored treatment for patients. General Scientific Summary: This study shows that high levels of cognitive and emotional empathy can buffer the negative effects of acute stress on social behavior in social anxiety disorder (SAD). Empathic abilities may be included as an additional diagnostic resource marker for SAD.

Effects of acute stress on social behavior in women.

Acute stress is known to increase prosocial behavior in men via a "tend-and-befriend" pattern originally proposed as a specifically female stress response alongside the fight-or-flight response. However, the direct effects of acute stress on women's social behavior have not been investigated. Applying the Trier Social Stress Test for groups (TSST-G), 94 women were confronted with either a stress or control condition. We repeatedly measured their subjective stress responses, salivary cortisol, and heart rate, and investigated their level of trust, trustworthiness, sharing, punishment and non-social risk using social decision paradigms. We detected significant increases in all stress parameters, as well as the wish for closeness during the stress condition. Acute stress exposure elevated prosocial trustworthiness and sharing without affecting non-social risk behavior. These results are in line with findings on the effects of stress in men, and further validate the tend-and-befriend pattern as one possible behavioral response during stress in humans.

Acute social and physical stress interact to influence social behavior: The role of social anxiety.

Stress is proven to have detrimental effects on physical and mental health. Due to different tasks and study designs, the direct consequences of acute stress have been found to be wide-reaching: while some studies report prosocial effects, others report increases in antisocial behavior, still others report no effect. To control for specific effects of different stressors and to consider the role of social anxiety in stress-related social behavior, we investigated the effects of social versus physical stress on behavior in male participants possessing different levels of social anxiety. In a randomized, controlled two by two design we investigated the impact of social and physical stress on behavior in healthy young men. We found significant influences on various subjective increases in stress by physical and social stress, but no interaction effect. Cortisol was significantly increased by physical stress, and the heart rate was modulated by physical and social stress as well as their combination. Social anxiety modulated the subjective stress response but not the cortisol or heart rate response. With respect to behavior, our results show that social and physical stress interacted to modulate trust, trustworthiness, and sharing. While social stress and physical stress alone reduced prosocial behavior, a combination of the two stressor modalities could restore prosociality. Social stress alone reduced nonsocial risk behavior regardless of physical stress. Social anxiety was associated with higher subjective stress responses and higher levels of trust. As a consequence, future studies will need to investigate further various stressors and clarify their effects on social behavior in health and social anxiety disorders.

Neural and psychophysiological markers of delay aversion in attention-deficit hyperactivity disorder.

Delay aversion (DAv) is thought to be a crucial factor in the manifestation of impulsive behaviors in patients with attention-deficit/hyperactivity disorder (ADHD). The imposition of delay is predicted to elicit negative emotional reactions in ADHD. The present study offers a multimodal approach to the investigation of DAv. Twelve adult patients with ADHD and 12 matched healthy controls were tested on a new task with several levels of anticipated delays during functional magnet resonance imaging (fMRI). Behavioral measures of delay discounting, DAv, and delay frustration were collected. Skin conductance and finger pulse rate were assessed. Results indicated a group difference in response to changes in delay in the right amygdala: For control participants activity decreased with longer delays, whereas activity tended to increase for ADHD patients. The degree of amygdala increase was correlated with the degree of behavioral DAv within the ADHD group. Patients also exhibited increased emotional arousal on physiological measures. These results support the notion of an exacerbated negative emotional state during the anticipation and processing of delay in ADHD.