It is estimated that roughly one third of adults in the US will be affected by a fear-related disorder over the course of their lifetime. These disorders, including diagnoses such as generalized anxiety disorder, social anxiety disorder, or post-traumatic stress disorder, are marked by disruptive fears that can interfere with daily life and have harmful long-term consequences on health and well-being. Yet, even the most successful treatment to date, exposure therapy (a set of procedures that employs fear extinction processes to reduce fear) has limited effects, with discomfort during therapy leading to drop-out and relapse remaining a common occurrence. Thus, investigation of methods to augment exposure therapy treatments and improve fear reduction strategies is critical for improving the well-being of individuals with fear-related disorders. Recent work has revealed that social support may represent one such method, demonstrating that social support reminders enhance the extinction of fear and reduce the acquisition of fear in healthy adults. These findings are unexpected, as they are in direct contrast with current views that all safety signals, including social support figures, are harmful during fear-reduction interventions. Thus, while current views would suggest that these cues reduce extinction and enhance acquisition, social support reminders in fact enhance extinction and reduce acquisition. This divergence may be explained by the crucial role of social support in human survival; specifically, the neurobiological mechanisms that have evolved to reinforce social bonds appear to overlap with the systems that support fear learning, making social support uniquely poised to reduce fear. These previous findings hint at the exciting possibility that social support may play an important role in improving outcomes for individuals with fear-related disorders. In particular, the presence of social support reminders (e.g., pictures) may augment exposure therapy treatments, enhancing extinction outcomes, and enrich strategies to prevent fear acquisition in individuals at risk for developing disruptive fears. However, while the fear-reducing effects of social support have been demonstrated in healthy adults, these effects have never been tested in adults with fear-related disorders. Thus, the proposed studies will be the first to explore whether social support 1) enhances fear extinction and 2) reduces fear acquisition in adults with social anxiety disorder (SAD) and healthy controls. In the first study, we will test whether the presence of a social support image (vs. smiling stranger image) leads to enhanced extinction in participants diagnosed with SAD (n=60, 30 females) and healthy controls (n=60, 30 females). In the second study, we will test whether the presence of a social support image (vs. smiling stranger image) reduces acquisition in participants with SAD (n=60, 30 females) and healthy controls (n=60, 30 females). This work will establish whether the fear-reducing effects of social support extend beyond healthy adults to those with fear-related disorders, potentially shedding light on simple, inexpensive ways to augment current fear reduction treatments and attenuate the formation of new fears.

Public Health Relevance

It is estimated that just under one third of the adult population in the US will suffer from an anxiety disorder in their lifetime, yet, even the most successful treatment for such disorders to date, exposure therapy, remains only partially effective; thus, investigation of methods to improve fear reduction outcomes is critical. Recent work hints at one such method, demonstrating that social support reminders both enhance fear extinction and reduce fear acquisition in healthy individuals, findings that suggest social support may augment the extinction processes by which exposure therapies reduce harmful fears as well as inform strategies to prevent the development of new fears. The focus of the proposed research is to take the first steps toward understanding the potential of social support to augment exposure therapies and inform fear-prevention strategies by testing whether the fear reducing effects of social support extend to individuals with fear-related disorders, enhancing extinction and reducing acquisition in participants diagnosed with social anxiety disorder.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Social Psychology, Personality and Interpersonal Processes Study Section (SPIP)
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Leitman, David I
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University of California Los Angeles
Schools of Arts and Sciences
Los Angeles
United States
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