Reduced optimism and a heightened neural response to everyday worries are specific to generalized anxiety disorder, and not seen in social anxiety

Abstract

Background Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) are comorbid and associated with similar neural disruptions during emotion regulation (Blair et al., 2012). In contrast, the lack of optimism examined here may occur specifically in GAD and could prove an important biomarker for that disorder. Methods Un-medicated individuals with GAD (n=18) and age, IQ and gender-matched SAD (n=18) and healthy (n=18) comparison individuals were scanned while contemplating likelihoods of high and low impact negative (e.g., having heart attack; getting heartburn) or positive (e.g., winning the lottery; getting a hug) events occurring to themselves in the future. Results In line with previous work, healthy subjects showed significant optimistic bias (OB); they considered themselves significantly less likely to experience future negative but significantly more likely to experience future positive events relative to others. This was also seen in SAD. However, GAD patients showed no OB for positive events and at the neural level showed significantly reduced modulation relative to the two other groups of regions including medial prefrontal cortex (mPFC) and caudate to these events. The GAD group further differed from the other groups by showing increased neural responses to low impact events in regions including rostral mPFC. Conclusions The form of neural dysfunction identified here may represent a unique feature associated with reduced optimism and increased worry about everyday events that occurs in GAD. Consistent with this possibility, patients with SAD did not show such dysfunction. Future studies should consider if this dysfunction represents an important biomarker for GAD.

Social optimism biases are associated with cortical thickness

“…Thus, a feeling of superiority may be biologically rooted and mediated by different processes: either by up-leveling oneself or by down-leveling disliked others. A mildly irrational optimistic belief in oneself compared with others appears to be healthy, and a lack of it has been associated with psychopathology ( Strunk et al ., 2006 ; Garrett et al ., 2014 ; Korn et al ., 2014 ; Blair et al ., 2017 ; Dricu et al ., in press ). However, the present study indicates that this belief shares a biological substrate with social biases that can discriminate against out-groups.…”

“…In summary, in the literature on personal optimistic bias, the insula, the ACC and the IFG stand out as those regions most reliably associated with personal optimism bias ( Harris and Fiske, 2007 ; Sharot et al ., 2007 ; Gozzi et al ., 2009 ; Singer et al ., 2009 ; Lamm et al ., 2011 ; Sharot et al ., 2012 ; Blair et al ., 2013 ; Marcoux et al ., 2013 ; Blair et al ., 2017 ; Kuzmanovic et al ., 2018 ; Dricu et al ., 2020 ). They are also implicated in social group perception ( Krill and Platek, 2009 ; Hein et al ., 2010 ; Harris and Fiske, 2011 ; Scheepers et al ., 2013 ) and are therefore most likely to be involved in social optimism bias.…”

Structural and functional neuroimaging studies in generalized anxiety disorder: a systematic review

“…exploring ER in a group of elderly GAD patients, showed a positive association between ER and global anxiety in the left parahippocampus, left and right precuneus, and right superior occipital gyrus, as well as a negative association between ER and worry severity in precuneus bilaterally. Finally, Blair et al117 showed that GAD patients had significantly reduced neural modulation in medial PFC and caudate during the processing of positive events, as well as increased neural responses to low-impact events in rostral medial PFC.…”

Prediction Error Representation in Individuals With Generalized Anxiety Disorder During Passive Avoidance

“…2, 3, 4) and clinical populations (2), particularly individuals with Generalized Anxiety Disorder (5) where reinforcement-based decision-making deficits are associated with symptom severity (5, 6). Individuals with Generalized Anxiety Disorder fail to fully show healthy optimistic bias, which has been associated with a failure to appropriately represent the value of positive events in medial prefrontal cortex (7), a region critical for reinforcement-based decision-making (8). However, the nature of the pathophysiology disrupting reinforcement-based decision-making in Generalized Anxiety Disorder remains largely unknown.…”