Behavioral and autonomic inflexibility in social anxiety disorder

Abstract

Social anxiety disorder (SAD) is a persistent and disabling disorder characterized by fears of negative evaluation and marked avoidance of social situations. Although influential psychological models have highlighted important cognitive and behavioral etiological features, none have specifically examined relationships with cardiovascular activity or decision-making as potential markers of dysfunction. Two such markers were explored in the present thesis: heart rate variability (HRV) and goal-directed behavior. Results demonstrated that although individuals with SAD exhibit decreased autonomic flexibility, this reduction did not predict changes in treatment outcome. Results also showed that impairments in goal-directed actions were characteristic of patients with SAD. In particular, this behavioral index was positively associated with symptom severity and predicted treatment outcome. The cumulative program of research presented in this thesis suggests that both autonomic and behavioral inflexibility are evident in SAD; both may therefore play a role in the etiology of the disorder and contribute to treatment outcomes. These results highlight the importance of targeted physiological and behavioral treatments, such as modifying cardiovascular disease risk factors or specific behavioral exposure therapies. Considering highly variable responses to psychological or pharmacological treatments in SAD, further investigation of the autonomic and behavioral factors in SAD may improve overall treatment outcomes.