Are individuals diagnosed with social anxiety disorder successful in regulating their emotions? A mixed-method investigation using self-report, subjective, and event-related potentials measures.

BACKGROUND: Models of social anxiety emphasize the role of emotion dysregulation, but the nature of these impairments needs clarification.
METHODS: We utilized a mixed-method approach to examine impairments in cognitive reappraisal and expressive suppression in social anxiety disorder. Forty nine treatment-seeking individuals diagnosed with social anxiety disorder and 35 healthy controls completed self-reports and a lab-based task of suppression and reappraisal. Unpleasantness ratings and event-related potentials (ERPs) were collected while participants regulated their emotions in response to shame-arousing pictures. ERP analyses focused on the late positive potential, a measure of increased attention to emotional stimuli that is reduced during emotion regulation.
RESULTS: Participants with social anxiety reported less frequent and effective use of reappraisal and more frequent and effective use of suppression than controls. Counter to most models and our hypotheses, participants with social anxiety were more successful than controls in lab-based reappraisal as measured by unpleasantness ratings, but no differences emerged for ERPs. No differences were found in measures of lab-based suppression. LIMITATIONS: Use of standardized, and not participant-generated, materials in the lab-based task of emotion regulation may limit the generalizability of the findings.
CONCLUSIONS: Subjective appraisals of self-efficacy and frequency suggest strong impairments in emotion-regulation in social anxiety that are not revealed in the laboratory. Models and treatment protocols should specify the exact nature of emotion dyregulation in social anxiety, highlighting difficulties in implementation of potentially intact emotion regulation abilities.