Brain scan study links social anxiety to an empathy "imbalance"

We all know the feeling: You are in a group of people, and suddenly, someone messes up big time. You cringe, wince, and look away — if it were you, you would be mortified. You are embarrassed for them. It's one of the most relatable aspects of social anxiety — and a new study points to the neurobiology that governs it.

More than one in ten American adults will experience social anxiety disorder over the course of their lives‚ feeling waves of distress pinned to social interaction. But some suffer from a specific kind of social anxiety — one that flips the usual feelings of embarrassment on their head.

Dubbed taijin-kyofusho, the word describes the sensation when people fear making others uncomfortable through physical or behavioral responses to humiliating situations — blushing during another's flubbed speech, for example, or inappropriately gazing at a bad karaoke singer caterwaul their way through 'Bohemian Rhapsody.'

“Both [taijin-kyofusho] and [social anxiety disorder] individuals excessively focus on others’ perspectives,” Shisei Tei, lead author on the new study and researcher at Kyoto University, tells Inverse.

Individuals with social anxiety disorder are often preoccupied with the fear of being criticized or scrutinized from others, and they often have heightened self-awareness, Tei says. These distractions can affect how they experience their own emotions.

People with taijin-kyofusho, on the other hand, are scared of causing others discomfort by virtue of their own physical and behavioral cues. They can end up ruminating on the feelings of others over their own. And that can negatively color the way these people experience the world.

In the new study, researchers scanned the brains of 23 people with taijin-kyofusho, discovering that specific pathways and cognitive functions go awry during embarrassing situations, heightening negative emotions.

The findings suggest that people with taijin-kyofusho traits feel the emotions of others more strongly than those without such traits, and that they also frequently misinterpret these emotions. They may also be inappropriately sensitive to others' emotions.

“Our brain and behavioral data suggest that people with social anxiety [taijin-kyofusho] may be characterized by not just only hypersensitive to other’s feelings, but also less accurate in recognizing emotion (how others are actually feeling about a person),” Shisei Tei, lead author on the new study and researcher at Kyoto University, tells Inverse.

The findings appeared Wednesday in the journal Proceedings of the National Academy of Sciences.

Glimpsing the brain

In the new study, the researchers wanted to see how signals in the brain might drive taijin-kyofusho during trying experiences. The study included 23 people living in Japan, the country where taijin-kyofusho was first identified in the 1990's.

First, they used questionnaires to measure the group’s empathy levels. They looked at affective empathy, or emotional contagion — the often subconscious phenomenon of emotion-sharing (seeing a person smiling makes another person happy, too, for example). They also looked at cognitive empathy, or perspective-taking — how accurately people understand other people’s emotions.

The researchers also measured the participants' levels of taijin-kyofusho traits to gauge how much these people feared their behavior or physicality would embarrass another person. They used these to calculate each person's taijin-kyofusho score, to represent how strong their taijin-kyofusho traits are.

Then, the research team scanned each person's brain using a functional magnetic resonance imaging (fMRI) machine, which maps brain activity. In the machine, participants watched short clips of people singing badly during a singing contest. Some of the performers acted embarrassed by their singing, while others acted proud, despite their lack of talent. The participants then watched the clips a second time outside the scanner and reported how embarrassed for the subject they felt.

People with more traits of taijin-kyofusho had reduced whole-brain cognitive connectivity when they watched the bad performers sing their hearts out.

At the same time, these participants' affective empathy ramped up, while their cognitive empathy reduced. They showed more activity in their amygdala, the brain’s emotional processor, and diminished activity in the posterior superior temporal sulcus and temporoparietal junction. Taken together, the results suggest it was harder for the taijin-kyofusho group to put the bad singers’ emotions in context, the researchers found.

Targets for improvement

The research suggests some people with taijin-kyofusho or social anxiety disorder may have “relatively reduced capacity in the flexible inference of other’s perspective,” Tei says. It may be more difficult for these people to shift attention away from negative ideas, on top of being hypersensitive to others' emotions.

The study brings researchers another step closer to understanding where "other-oriented" fears play out in the brain, an inquiry that has never been tested before.

In contrast, social anxiety's cognitive roots have been explored in the past, with research suggesting that people with negative emotional reactivity may have reduced cognitive regulation-related neural activity.

The new study is small and limited to a culturally homogenous group, so more research is needed to determine exactly how brain functioning influences the distressing experiences of taijin-kyofusho and wider social anxiety disorder.

If replicated in larger and more diverse samples, the findings could eventually lead to novel treatments for these disorders. Down the line, these treatments could improve the quality of life of all the people out there who are walking on eggshells to avoid embarrassing others.

Abstract: Social-anxiety disorder involves a fear of embarrassing oneself in the presence of others. Taijin-kyofusho (TKS), a subtype common in East Asia, additionally includes a fear of embarrassing others. TKS individuals are hypersensitive to others’ feelings and worry that their physical or behavioral defects humiliate others. To explore the underlying neurocognitive mechanisms, we compared TKS ratings with questionnaire-based empathic disposition, cognitive flexibility (set-shifting), and empathy-associated brain activity in 23 Japanese adults. During 3-tesla functional MRI, subjects watched video clips of badly singing people who expressed either authentic embarrassment (EMBAR) or hubristic pride (PRIDE). We expected the EMBAR singers to embarrass the viewers via emotion- sharing involving affective empathy (affEMP), and the PRIDE singers to embarrass via perspective-taking involving cognitive empathy (cogEMP). During affEMP (EMBAR > PRIDE), TKS scores correlated positively with dispositional affEMP (personal-distress dimension) and with amygdala activity. During cogEMP (EMBAR < PRIDE), TKS scores correlated negatively with cognitive flexibility and with activity of the posterior superior temporal sulcus/temporoparietal junction (pSTS/TPJ). Intersubject correlation analysis implied stronger involvement of the anterior insula, inferior frontal gyrus, and premotor cortex during affEMP than cogEMP and stronger involvement of the medial prefrontal cortex, posterior cingulate cortex, and pSTS/TPJ during cogEMP than affEMP. During cogEMP, the whole-brain functional connectivity was weaker the higher the TKS scores. The observed imbalance between affEMP and cogEMP, and the disruption of functional brain connectivity, likely deteriorate cognitive processing during embarrassing situations in persons who suffer from other-oriented social anxiety dominated by empathic embarrassment.