Social Anxiety Disorder (SAD) and Feedback Processing

Patients with social axiety disorder (SAD) are very concerned for getting negative feedback from others (Voegler, Peterburs, Bellebaum, and Straube, 2019). SAD patients have the fear that their actions may be judged as abnormal or embarrasing. Learning from feedback is an important aspect for the succesful accomplishment of interactions with the environment, allowing contingency learning among actions and their effects and waiting for the consequences of particular behavior (Voegler et al., 2019).

The authors used a probabilistic feedback learning task while recording event related potentials and their interaction with the social context in patients with SAD and healthy control subjects. During the task feedback was given as wins or losses and were either rewarded or punished. Two conditions of the task consisted of either being obseved or as being not obseved by an observer (Voegler et al., 2019).

It was found that the patients with SAD were more unconfortable than healthy control subjects during the observation condition of the task. Furthermore, the patients with SAD did learn better from negative feedback compared to positive feedback during the no obsevation condition of the task, wheras the opposite did hold for the healthy control subjects. The ERP results showed that patients with SAD showed an enhanced feedback relativity (FRN) component amplitude during observation. The effect was more evident related to positive feedback. The results of the difference FRN and learning from negative feedback in the SAD patients was negativily associated with this component in the patients with SAD in the no obsevation condition, but not in the observation condition. In contrast, the opposite was found in healthy control subjects (Voegler et al., 2019). 

It is suggested that healthy control subjects are more relying on an avoidance-oriented strategy when they are being observed, such as social stress. The patients with SAD, however, are more implicated for negative information by default.

The results may opt for an inadequate information processing style in patients with SAD while they are being obseved with regard to the neural level. This might be due to a indefinite separation of reinforcement that is either negative or positive and as a result learning from negative feedback is impaired in these patients (Voegler et al., 2019).