Background

In recent years, a growing body of eye-tracking research has investigated gaze behavior in individuals with social anxiety during the visual perception of emotional stimuli. The aim of this article was to review and synthesize studies examining attention orientation in patients with clinical social anxiety by means of eye-tracking methodology.

Methods

Through a systematic search, 30 articles were identified, including 11 studies in which single emotional faces were used as stimuli and seven eligible studies in which threatening faces were paired with neutral stimuli. Meta-analyses were conducted to compare prolonged eye-contact behavior and early attentional biases to threats in individuals with social anxiety disorder (SAD) and healthy controls.

Results

Moderate group differences were revealed for single face viewing studies, with SAD patients showing significantly reduced eye contact with negative (Hedges' g = −0.67) and positive emotional faces (g = −0.49) compared to that of healthy participants. Type of task and duration of stimulus presentation were (marginally) significant moderators of between-study variance in effect size. Small but significant group differences were found for early attentional biases toward angry faces versus neutral stimuli (g = 0.21) but not toward happy faces versus neutral stimuli (g = 0.05). Preliminary evidence for a hyperscanning strategy in SAD patients relative to healthy controls emerged (g = 0.42).

Limitations

The number of included studies with face pairings was low, and two studies were excluded due to unavailable data.

Conclusions

Our results suggest that eye contact avoidance with emotional faces is a prominent feature in SAD patients. Patients might benefit from guidance to learn to make adequate eye contact during therapeutic interventions, such as exposure therapy. SAD patients demonstrated slightly heightened attention allocation toward angry faces relative to that of healthy participants during early processing stages. Threat biases can be potential targets for attention modification training as an adjuvant to other treatments. Future research on early attentional processes may benefit from improved arrangements of paired stimuli to increase the psychometric properties of initial attention indices.

背景

近年来，越来越多的眼动追踪研究调查了社交焦虑症患者在视觉感知情绪刺激期间的凝视行为。本文的目的是回顾和综合研究通过眼动追踪方法检查临床社交焦虑患者注意力取向的研究。

方法

通过系统搜索，确定了 30 篇文章，其中包括 11 篇使用单一情绪面孔作为刺激的研究和 7 项符合条件的研究，其中威胁面孔与中性刺激配对。进行了荟萃分析，以比较社交焦虑症 (SAD) 和健康对照者的长时间眼神接触行为和早期注意偏见对威胁的影响。

结果

单面观察研究显示出适度的组间差异，与 健康参与者相比， SAD 患者与负面（Hedges' g  = -0.67）和积极情绪面孔（g = -0.49）的眼神接触显着减少。任务类型和刺激呈现的持续时间（略微）是研究间效应大小差异的显着调节因素。对于愤怒的面孔与中性刺激的早期注意偏差（ g  = 0.21），但对于快乐的面孔与中性刺激（g  = 0.05）没有发现小但显着的组差异。与健康对照相比，出现了 SAD 患者超扫描策略的初步证据 ( g  = 0.42)。

限制

包含面部配对的研究数量很少，有两项研究由于数据不可用而被排除在外。

结论

我们的研究结果表明，避免与情绪化面孔进行眼神接触是 SAD 患者的一个突出特征。患者可能会受益于指导，以学习在治疗干预期间进行充分的眼神交流，例如暴露疗法。在早期处理阶段，与健康参与者相比，SAD 患者对愤怒面孔的注意力分配略有增加。威胁偏差可能是注意力修正训练的潜在目标，作为其他治疗的辅助手段。未来对早期注意过程的研究可能会受益于配对刺激的改进安排，以增加初始注意指数的心理测量特性。