The role of amygdala subregions in the neurobiology of social anxiety disorder

Social anxiety is characterised by fear and/or avoidance of social situations in which an individual may be scrutinised by others. Social anxiety is thought to exist as a spectrum, with individuals on the high-end experiencing frequent and severe anxiety in the context of social situations. When severe social anxiety is accompanied by distress and functional impairment, a diagnosis of social anxiety disorder (SAD) can be made. SAD is a prevalent and debilitating disorder that can be unremitting and pervasive in the absence of intervention. Current psychotherapeutic and pharmacotherapeutic treatments for SAD demonstrate limited efficacy in remitting symptoms. Therefore, it is important to achieve a better understanding of the neurobiological mechanisms implicated in this disorder and identify potential neural treatment targets to develop more efficacious treatments.

This thesis aimed to further investigate the neurobiological mechanisms implicated in SAD (vs. controls) and the associations between neural functioning and social anxiety as a dimensional symptom, with a focus on the amygdala and four of its subregions (the amygdalostriatal, basolateral, centromedial, and superficial subregions). This was due to previous findings in the neuroimaging literature in SAD having consistently implicated the amygdala, albeit with mixed findings of both increased and decreased functioning in those with SAD compared to controls. In the literature to date, however, most studies had examined the amygdala as a singular homogenous region due to methodological limitations in being able to examine the functionally and structurally distinct subnuclei that make up this region. By examining the amygdala subregions through the use of multiband functional magnetic resonance imaging (fMRI), this thesis additionally sought to determine whether the mixed findings in the literature to date may be a result of amygdala subregion-specific activity and connectivity patterns.

This was achieved through three research studies. Firstly, Study 1 involved a comprehensive systematic review that summarised the literature on resting-state neuroimaging in SAD with a focus on fMRI studies and findings specific to the amygdala and its subregions (Chapter 3). This was followed by two empirical studies which investigated the role of the amygdala and its subregions during resting-state (Study 2) and emotion processing (Study 3) fMRI paradigms (Chapters 5 and 6, respectively).

Findings from the systematic review (Study 1) highlighted the mixed findings in the resting-state neuroimaging literature in SAD to date, along with methodological limitations relating to neuroimaging acquisition and analysis. The empirical studies sought to address these limitations and demonstrated differing amygdala subregion activity and connectivity patterns at rest and during emotion processing. In the resting-state fMRI study (Study 2), there were no statistically significant differences in functional connectivity of the amygdala and its subregions in those with SAD compared to controls. However, social anxiety severity was found to be positively associated with connectivity between the superficial subregion and the supramarginal gyrus. The superficial subregion, along with the basolateral and centromedial subregions, were also implicated in the task-based emotion processing fMRI study (Study 3). In response to happy, angry, and fearful faces, those with SAD (vs. controls) had hyperactivation of the superficial subregion, hypoconnectivity between the superficial subregion and the precuneus, and hyperconnectivity between the basolateral subregion and broader brain regions (i.e., the pre/postcentral gyrus and the supramarginal gyrus). Additionally, social anxiety severity was positively associated with superficial and centromedial activation.

Overall, the findings from this thesis provide novel information to the current understanding of the neurobiology of SAD by demonstrating amygdala subregion-specific alterations. This has important implications for research, theory, and clinical practice that are detailed in the thesis discussion (Chapter 7). Briefly, in terms of research, findings from the thesis provide support for the continuing investigation of SAD using both dimensional and categorical approaches. This was evident by the findings from the two empirical papers which demonstrated positive associations between subregional activity and connectivity patterns and social anxiety severity. With regards to theory, differences in neural patterns that were observed at rest (Study 2) and during emotion processing (Study 3) provide support for distinct neurobiological models to be constructed based on whether those with SAD are in the absence or presence of social stimuli. This is in contrast to the most recently proposed neurobiological model of SAD which was informed by a combination of resting-state and task-based fMRI data. Finally, with regards to clinical practice, the findings from this thesis provide preliminary evidence of the superficial, basolateral, and centromedial subregions of the amygdala as being potential treatment targets that can be used to inform the development of more efficacious treatments for SAD.