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Reduced neural activation during positive social approach is associated with better response to approach avoidance training for social anxiety disorder

Christopher Hunt,Morgan M. Caudle,Martin P. Paulus,Murray B. Stein,Charles T. Taylor,J. Bomyea

Published 2025 in Journal of mood and anxiety disorders

ABSTRACT

Introduction Accumulating evidence suggests that social anxiety disorder (SAD) is characterized by diminished approach of positive social stimuli. Approach-positive approach-avoidance training (AP-AAT) may reduce this bias, but its results have been mixed. AP-AAT might be more effective for patients with deficits in the neural approach processes AP-AAT targets. Here, we attempted to identify neural areas underlying reduced approach of positive social stimuli in SAD and explore whether activity in such areas predicted response to AP-AAT. Method This was a secondary analysis of an AP-AAT clinical trial involving 40 SAD participants and 22 healthy controls (HCs). A social approach-avoidance task was completed during fMRI to identify neural activation differences between SAD and HC subjects when approaching positive social cues. SAD participants were then randomized to AP-AAT (n = 18) or sham training (n = 22). Treatment response was assessed by changes in positive affect and social connection from pre-to-post treatment. Results Compared to HCs, SAD patients exhibited significantly less activation in the left paracentral lobule (PCL), right superior parietal lobule (SPL), and left lingual gyrus (LG) when approaching relative to avoiding positive social cues. Lower activation in the right SPL (b=-7.15, p = .022) and left LG (b=-6.93, p = .007) during social approach versus avoidance predicted greater improvement in positive affect (but not social connection) in the AP-AAT group relative to sham. Conclusions Lower neural activation during positive social approach at baseline predicted better AP-AAT response. AP-AAT may be particularly well-suited to SAD patients exhibiting the neural approach deficits that the treatment putatively targets. ClinicalTrials.gov Identifier NCT02136212

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