Adolescent social anxiety is associated with diminished discrimination of anticipated threat and safety

Description: Social anxiety—which typically emerges in adolescence—lies on a continuum and, when extreme, can be devastating, with significant impairment evident even at subclinical levels. Socially anxious individuals are prone to heightened fear, anxiety, and avoidance of social interactions and contexts associated with the potential for social scrutiny. To date, most neuroimaging research has focused on acute social threat. Much less scientific attention has been devoted to understanding the neural systems recruited during the anticipation of potential encounters with social threat. Here we combined functional MRI with a novel social threat-anticipation paradigm in a racially diverse sample of 66 adolescents selectively recruited to encompass a broad spectrum of symptoms and enriched for clinically significant levels of distress and impairment. Results demonstrated that socially anxious adolescents experience elevated fear and anxiety when anticipating encounters with threatening faces and voices, and indiscriminately elevated distress during the anticipation of benign social cues. Adolescents with more severe symptoms also showed reduced discrimination of uncertain social threat and safety in the bed nucleus of the stria terminalis (BST), a key division of the central extended amygdala (EAc). Although the EAc was robustly engaged by the acute presentation of threatening faces and voices, variation in EAc reactivity was unrelated to symptom severity. These observations provide a neurobiologically grounded framework for conceptualizing adolescent social anxiety and set the stage for the kinds of prospective-longitudinal and mechanistic research that will be necessary to determine causation and, ultimately, to develop improved interventions for this often-debilitating illness.