MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder

Jason Luoma, M Kati Lear, Jason Luoma, M Kati Lear

Abstract

Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.

Keywords: MDMA-assisted therapy; shame; social anhedonia; social anxiety disorder; social functioning; social threat.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Luoma and Lear.

References

    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence of age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. (2005) 62:593–602. 10.1001/archpsyc.62.6.593
    1. American Psychiatric Association (APA) . Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association; (2013).
    1. Fehm L, Pelissolo A, Furmark T, Wittchen HU. Size and burden of social phobia in Europe. Eur Neuropsychopharmacol. (2005) 15:453–62. 10.1016/j.euroneuro.2005.04.002
    1. Fehm L, Beesdo K, Jacobi F, Fiedler A. Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity, and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol. (2008) 43:257–65. 10.1007/s00127-007-0299-4
    1. Issakidis C, Sanderson K, Corry J, Andrews G, Lapsley H. Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders. Psychol Med. (2004) 34:19–35. 10.1017/s003329170300881x
    1. Stuhldreher N, Leibing E, Leichsenring F, Beutel ME, Herpertz S, Hoyer J, et al. . The costs of social anxiety disorder: the role of symptom severity and comorbidities. J Affect Disord. (2014) 165:87–94. 10.1016/j.jad.2014.04.039
    1. Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. J Psychiatr Res. (2008) 42:230–9. 10.1016/j.jpsychires.2007.01.002
    1. Oliveira LM, Bermudez MB, de Amorim Macedo MJ, Passos IC. comorbid social anxiety disorder in patients with alcohol use disorder: a systematic review. J Psychiatr Res. (2018) 106:8–14. 10.1016/j.jpsychires.2018.09.008
    1. Adams GC, Balbuena L, Meng XF, Asmundson GJG. When social anxiety and depression go together: a population study of comorbidity and associated consequences. J Affect Disord. (2016) 206:48–54. 10.1016/j.jad.2016.07.031
    1. Ohayon MM, Schatzberg AF. Social phobia and depression: prevalence and comorbidity. J Psychosom Res. (2010) 3:235–43. 10.1016/j.jpsychores.2009.07.018
    1. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, et al. . An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. (2017) 152:157–71. 10.1016/j.puhe.2017.07.035
    1. Wong QJJ, Rapee RM. (2016). The aetiology and maintenance of social anxiety disorder: a synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord. (2016) 203:84–100. 10.1016/j.jad.2016.05.069
    1. Weiller E, Bisserbe JC, Boyer P, Lepine JP, Lecrubier Y. Social phobia in general health care: an unrecognised undertreated disabling disorder. Br J Psychiatry. (1996) 168:169–74. 10.1192/bjp.168.2.169
    1. Williams T, McCaul M, Schwarzer G, Cipriani A, Stein DJ, Ipser J. Pharmacological treatments for social anxiety disorder in adults: a systematic review and network meta-analysis. Acta Neuropsychiatr. (2020) 32:169–76. 10.1017/neu.2020.6
    1. Mayo-Wilson E, Dias S, Mavranezouli I, Kew K, Clark DM, Ades AE, et al. . Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry. (2014) 1:368–76. 10.1016/S2215-0366(14)70329-3
    1. Steinert C, Hofmann M, Leichsenring F, Kruse J. What do we know today about the prospective long-term course of social anxiety disorder? A systematic literature review. J Anxiety Disord. (2013) 27:692–702. 10.1016/j.janxdis.2013.08.002
    1. Mataix-Cols D, De La Cruz LF, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, et al. . D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders a systematic review and meta-analysis of individual participant data. JAMA Psychiatry. (2017) 74:501–10. 10.1001/jamapsychiatry.2016.3955
    1. Bejerot S, Eriksson JM. Mortberg, E. Social anxiety in adult autism spectrum disorder. Psychiatry Res. (2014) 220:705–7. 10.1016/j.psychres.2014.08.030
    1. Mitchell JM, Bogenschutz M, Lilienstein A, Harrison C, Kleiman S, Parker-Guilbert K, et al. . Phase 3 MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med. (2021) 27:1025–33. 10.1038/s41591-021-01336-3
    1. Mithoefer MC, Feduccia AA, Jerome L, Mithoefer A, Wagner M, Walsh Z, et al. . MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology. (2019) 236:2735–45. 10.1007/s00213-019-05249-5
    1. Bahji A, Forsyth A, Groll D, Hawken ER. Efficacy of 3,4 Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: a systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. (2020) 96:109735. 10.1016/j.pnpbp.2019.109735
    1. Heifets BD, Malenka RC. MDMA as a probe and treatment for social behaviors. Cell. (2016) 166:269–72. 10.1016/j.cell.2016.06.045
    1. Passie T, Hartmann U, Schneider U, Emrich HM, Krüger THC. Ecstasy (MDMA) mimics the post-orgasmic state: impairment of sexual drive and function during acute MDMA-effects may be due to increased prolactin secretion. Med Hypotheses. (2005) 64:899–903. 10.1016/j.mehy.2004.11.044
    1. Mas M, Farre M., de la Torre R, Roset PN, Ortuno J, Segura J, et al. . Cardiovascular and neuroendocrine effects and pharmacokinetics of 3, 4-methylenedioxymethamphetamine in humans. J Pharmacol Exp Ther. (1999) 290:136–45.
    1. Emanuele E, Arra M, Pesenti S. Vasopressin and oxytocin as neurohormonal mediators of mdma (ecstasy) sociosexual behavioural effects. Med Hypotheses. (2006) 67:1250–1. 10.1016/j.mehy.2006.05.021
    1. Liechti ME, Vollenweider FX. Which neuroreceptors mediate the subjective effects of MDMA in humans? A summary of mechanistic studies. Hum Psychopharmacol. (2001) 16:589–98. 10.1002/hup.348
    1. Studerus E, Gamma A, Vollenweider FX. Psychometric evaluation of the altered states of consciousness rating scale (OAV). PLoS ONE. (2010) 5:e0012412. 10.1371/journal.pone.0012412
    1. Passie T. The early use of MDMA (‘Ecstasy') in Psychotherapy (1977–1985). Drug Sci Policy Law. (2018) 4:205032451876744. 10.1177/2050324518767442
    1. Hayes SC, Hofmann SG, Stanton CE, Carpenter JK, Sanford BT, Curtiss JE, et al. . The role of the individual in the coming era of process-based therapy. Behav Res Ther. (2019) 117:40–53. 10.1016/j.brat.2018.10.005
    1. Gilboa-Schechtman E, Shachar I, Sahar Y. Positivity impairment as a broad-based feature of social anxiety. In: Weeks JW. editor. The Wiley Blackwell Handbook of Social Anxiety Disorder. Hoboken, NJ: Wiley-Blackwell; (2014). p. 409–32.
    1. Richey JA, Brewer JA, Sullivan-Toole H, Strege MV, Kim-Spoon J, White SW, et al. . Sensitivity shift theory: a developmental model of positive affect and motivational deficits in social anxiety disorder. Clin Psychol Rev. (2019) 72:101756. 10.1016/j.cpr.2019.101756
    1. Amir N, Prouvost C, Kuckertz JM. (2012). Lack of a benign interpretation bias in social anxiety disorder. Cogn Behav Ther. (2012) 41:119–29. 10.1080/16506073.2012.662655
    1. Caouette JD, Guyer AE. Cognitive distortions mediate depression and affective response to social acceptance and rejection. J Affect Disord. (2016) 190:792–9. 10.1016/j.jad.2015.11.015
    1. Gable SL, Gosnell CL. (2013). Approach and avoidance behavior in interpersonal relationships. Emot Rev. (2013) 5:269–74. 10.1177/1754073913477513
    1. Gilboa-Schechtman E, Keshet H, Peschard V, Azoulay R. (2020). Self and identity in social anxiety disorder. J Pers. (2020) 88:106–21. 10.1111/jopy.12455
    1. Beltzer ML, Adams S, Beling PA, Teachman BA. Social anxiety and dynamic social reinforcement learning in a volatile environment. Clin Psychol Sci. (2019) 7:1372–88. 10.1177/2167702619858425
    1. Kashdan TB, Weeks JW, Savostyanova AA. Whether, how, and when social anxiety shapes positive experiences and events: a self-regulatory framework and treatment implications. Clin Psychol Rev. (2011) 31:786–99. 10.1016/j.cpr.2011.03.012
    1. Alden LE, Wallace ST. (1995). Social phobia and social appraisal in successful and unsuccessful social interactions. Behav Res Ther. (1995) 33:497–505. 10.1016/0005-7967(94)00088-2
    1. Wallace ST, Alden LE. Social phobia and positive social events: the price of success. J Abnorm Psychol. (1997) 106:416. 10.1037//0021-843x.106.3.416
    1. Alden LE, Taylor CT, Mellings TMJB, Laposa JM. Social anxiety and the interpretation of positive social events. J Anxiety Disord. (2008) 22:577–90. 10.1016/j.janxdis.2007.05.007
    1. Morrison AS, Mateen MA, Brozovich FA, Zaki J, Goldin PR, Heimberg RG, et al. . Changes in empathy mediate the effects of cognitive-behavioral group therapy but not mindfulness-based stress reduction for social anxiety disorder. Behav Ther. (2019) 50:1098–111. 10.1016/j.beth.2019.05.005
    1. Plasencia ML, Taylor CT, Alden LE. unmasking one's true self facilitates positive relational outcomes: authenticity promotes social approach processes in social anxiety disorder. Clin Psychol Sci. (2016) 4:1002–14. 10.1177/2167702615622204
    1. Taylor CT, Alden LE. To see ourselves as others see us: an experimental integration of the intra and interpersonal consequences of self-protection in social anxiety disorder. J Abnorm Psychol. (2011) 120:129. 10.1037/a0022127
    1. Jungaberle H, Thal S, Zeuch A, Rougemont-Bücking A, von Heyden M, Aicher H, et al. . Positive psychology in the investigation of psychedelics and entactogens: a critical review. Neuropharmacology. (2018) 142:179–99. 10.1016/j.neuropharm.2018.06.034
    1. Carter CS, Grippo AJ, Pournajafi-Nazarloo H, Ruscio MG, Porges SW. Oxytocin, vasopressin and sociality. Prog Brain Res. (2008) 170:331–6. 10.1016/S0079-6123(08)00427-5
    1. Kemp AH, Quintana DS, Kuhnert R-L, Griffiths K, Hickie IB, Guastella AJ. Oxytocin increases heart rate variability in humans at rest: implications for social approach-related motivation and capacity for social engagement. PLoS ONE. (2012) 7:e44014. 10.1371/journal.pone.0044014
    1. Ago Y, Nakamura S, Baba A, Matsuda T. Neuropsychotoxicity of abused drugs: effects of serotonin receptor ligands on methamphetamine- and cocaine-induced behavioral sensitization in mice. J Pharmacol Sci. (2008) 106:15–211. 10.1254/jphs.FM0070121
    1. Auclair A, Drouin C, Cotecchia S, Glowinski J, Tassin J-P. 5-HT2A and Alpha1b-adrenergic receptors entirely mediate dopamine release, locomotor response and behavioural sensitization to opiates and psychostimulants. Eur J Neurosci. (2004) 20:3073–84. 10.1111/j.1460-9568.2004.03805.x
    1. Zayara AE, McIver G, Valdivia PN, Lominac KD, McCreary AC, Szumlinski KK. Blockade of nucleus accumbens 5-HT2A and 5-HT2C receptors prevents the expression of cocaine-induced behavioral and neurochemical sensitization in rats. Psychopharmacology (Berl). (2011) 213:321–35. 10.1007/s00213-010-1996-3
    1. Nardou R, Lewis EM, Rothhaas R, Xu R, Yang A, Boyden E, et al. . (2019). Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Nature. (2019) 569:116–20. 10.1038/s41586-019-1075-9
    1. Curry DW, Berro LF, Belkoff AR, Sulima A, Rice KC, Howell LL. Sensitization to the Prosocial Effects of 3,4-Methylenedioxymethamphetamine (MDMA). Neuropharmacology. (2019) 151:13–20. 10.1016/j.neuropharm.2019.03.017
    1. Danforth AL, Grob CS, Struble C, Feduccia AA, Walker N, Jerome L, et al. . Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology (Berl). (2018) 235:3137–48. 10.1007/s00213-018-5010-9
    1. Tiedens LZ, Fragale AR. Power moves: complementarity in dominant and submissive nonverbal behavior. J Pers Soc Psychol. (2003) 84:558–68. 10.1037/0022-3514.84.3.558
    1. Blair K, Geraci M, Devido J, McCaffrey D, Chen G, Vythilingam M, et al. . Neural response to self- and other referential praise and criticism in generalized social phobia. Arch Gen Psychiatry. (2008) 65:1176–84. 10.1001/archpsyc.65.10.1176
    1. Lorberbaum JP, Kose S, Johnson MR, Arana GW, Sullivan LK, Hamner MB, et al. . Neural correlates of speech anticipatory anxiety in generalized social phobia. Neuroreport. (2004) 15:2701–5.
    1. Phan KL, Fitzgerald DA, Nathan PJ, Tancer ME. Association between amygdala hyperactivity to harsh faces and severity of social anxiety in generalized social phobia. Biol Psychiatry. (2006) 59:424–9. 10.1016/j.biopsych.2005.08.012
    1. Asher M, Aderka IM. Dating with social anxiety: an empirical examination of momentary anxiety and desire for future interaction. Clin Psychol Sci. (2020) 8:99–110. 10.1177/2167702619867055
    1. Voncken MJ, Dijk C, Lang WG, Boots LMM, Roelofs J. Behavior when socially anxious individuals expect to be (Dis)liked: the role of self-disclosure and mimicry in actual likeability. J Behav Ther Exp Psychiatry. (2020) 69:101574. 10.1016/j.jbtep.2020.101574
    1. Kashdan TB, Doorley J, Stiksma MC, Hertenstein MJ. Discomfort and avoidance of touch: new insights on the emotional deficits of social anxiety. Cogn Emot. (2017) 31:1638–46. 10.1080/02699931.2016.1256867
    1. Fetzner MG, Teale Sapach MJN, Mulvogue M, Carleton RN. “It's not just about being judged”: interpersonal distrust uniquely contributes to social anxiety. J Exp Psychopathol. (2016) 7:31–40. 10.5127/jep.042414
    1. Hattingh CJ, Ipser J, Tromp SA, Syal S, Lochner C, Brooks SJ, et al. . Functional magnetic resonance imaging during emotion recognition in social anxiety disorder: an activation likelihood meta-analysis. Front Hum Neurosci. (2013) 6:347. 10.3389/fnhum.2012.00347
    1. Suveg C, Kingery JN, Davis M, Jones A, Whitehead M, Jacob ML. Still lonely: social adjustment of youth with and without social anxiety disorder following cognitive behavioral therapy. J Anxiety Disord. (2017) 52:72–8. 10.1016/j.janxdis.2017.10.005
    1. Porges SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation (Norton Series on Interpersonal Neurobiology). New York, NY: W.W. Norton & Company; (2011). p. 347.
    1. Lynch TR. Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Oakland, CA: New Harbinger; (2018). p. 520.
    1. Thayer JF, Lane RDA. Model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord. (2000) 61:201–16. 10.1016/s0165-0327(00)00338-4
    1. Pittig A, Arch JJ, Lam CWR, Craske MG. Heart rate and heart rate variability in panic, social anxiety, obsessive-compulsive, and generalized anxiety disorders at baseline and in response to relaxation and hyperventilation. Int J Psychophysiol. (2013) 87:19–27. 10.1016/j.ijpsycho.2012.10.012
    1. Alvares GA, Quintana DS, Kemp AH, Van Zwieten A, Balleine BW, Hickie IB, et al. . Reduced heart rate variability in social anxiety disorder: associations with gender and symptom severity. PLoS ONE. (2013) 8e70468. 10.1371/journal.pone.0070468
    1. Miles LK, Nind LK, Henderson Z, Macrae CN. Moving memories: behavioral synchrony and memory for self and others. J Exp Soc Psychol. (2010) 46:457–60. 10.1016/j.jesp.2009.12.006
    1. Asher M, Kauffmann A, Aderka IM. Out of sync: nonverbal synchrony in social anxiety disorder. Clinc Psychol Sci. (2020) 8:280–94. 10.1177/2167702619894566
    1. Anderl C, Steil R, Hahn T, Hitzeroth P, Reif A, Windmann S. Reduced reciprocal giving in social anxiety - evidence from the trust game. J Behav Ther Exp Psychiatry. (2018) 59:12–8. 10.1016/j.jbtep.2017.10.005
    1. Ketay S, Welker KM, Beck LA, Thorson KR, Slatcher RB. Social anxiety, cortisol, and early-stage friendship. J Soc Pers Relat. (2019) 36:1954–74. 10.1177/0265407518774915
    1. Alden LE, Buhr K, Robichaud M, Trew JL, Plasencia ML. Treatment of social approach processes in adults with social anxiety disorder. J Consult Clin Psychol. (2018) 86:505–17. 10.1037/ccp0000306
    1. Shahar B, Bar-Kalifa E, Alon E. Emotion-focused therapy for social anxiety disorder: results from a multiple-baseline study. J Consult Clin Psychol. (2017) 85:238–49. 10.1037/ccp0000166
    1. Trew JL, Alden LE. Kindness reduces avoidance goals in socially anxious individuals. Motiv Emot. (2015) 39:892–907. 10.1007/s11031-015-9499-5
    1. Vernberg EM, Abwender DA, Ewell KK, Beery SH. Social anxiety and peer relationships in early adolescence: a prospective analysis. J Clin Child Psychol. (1992) 21:189–96. 10.1207/s15374424jccp2102_11
    1. Morrison AS, Mateen MA, Brozovich FA, Zaki J, Goldin PR, Heimberg RG, et al. . Empathy for positive and negative emotions in social anxiety disorder. Behav Res Ther. (2016) 87:232–42. 10.1016/j.brat.2016.10.005
    1. Arditte Hall KA, Joormann J, Siemer M, Timpano KR. The impact bias in self and others: affective and emptathic forecasting in individuals with social anxiety. Behav Res Ther. (2018) 106:37–46. 10.1016/j.brat.2018.05.001
    1. Barone WJ. The role of MDMA as an adjunct to therapy for adults with PTSD, as illustrated by participant qualitative data one-year posttreatment (dissertation). Pleasant Hill, CA: John F. Kennedy University; (2017).
    1. Gilbert P. The relationship of shame, social anxiety and depression: the role of the evaluation of social rank. Clin Psychol Psychother. (2000) 7:174–89. 10.1002/1099-0879(200007)7:3<174::AID-CPP236>;2-U
    1. Weeks JW, Howell AN, Srivastav A, Goldin PR. “Fear guides the eyes of the beholder”: assessing gaze avoidance in social anxiety disorder via covert eye tracking of dynamic social stimuli. J Anxiety Disord. (2019) 65:56–63. 10.1016/j.janxdis.2019.05.005
    1. Reichenberger J, Wiggert N, Wilhelm FH, Liedlgruber M, Voderholzer U, Hillert A, et al. . Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder. Behav Res Ther. (2019) 116:140–8. 10.1016/j.brat.2019.03.009
    1. Bershad AK, Miller MA, Baggott MJ, De Wit H. The effects of MDMA on socio-emotional processing: does MDMA differ from other stimulants? J Psychopharmacol. (2016) 30:1248–58. 10.1177/0269881116663120
    1. Kok BE, Fredrickson BL. Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness. Biol Psychol. (2010) 85:432–6. 10.1016/j.biopsycho.2010.09.005
    1. Arai A, Hirota Y, Miyase N, Miyata S, Young LJ, Osako Y, et al. . A single prolonged stress paradigm produces enduring impairments in social bonding in monogamous prairie voles. Behav Brain Res. (2016) 315:83–93. 10.1016/j.bbr.2016.08.022
    1. Tangney JP, Dearing RL. Shame and Guilt. New York, NY: The Guilford Press; (2002). p. 272.
    1. Cândea DM, Szentágotai-Tǎtar A. The impact of self-compassion on shame-proneness in social anxiety. Mindfulness. (2018) 9:1816–24. 10.1007/s12671-018-0924-1
    1. Shahar B, Doron G, Szepsenwol O. Childhood maltreatment, shame-proneness and self-criticism in social anxiety disorder: a sequential mediational model. Clin Psychol Psychother. (2015) 22:570–9. 10.1002/cpp.1918
    1. Fergus TA, Valentiner DP, McGrath PB, Jencius S. Shame- and guilt-proneness: relationships with anxiety disorder symptoms in a clinical sample. J Anxiety Disord. (2010) 24:811–5. 10.1016/j.janxdis.2010.06.002
    1. Gilbert P. The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. Br J Med Psychol. (1997) 70:113–47. 10.1111/j.2044-8341.1997.tb01893.x
    1. Sznycer D, Tooby J, Cosmides L, Porat R, Shalvi S, Halperin E. Shame closely tracks the threat of devaluation by others, even across cultures. Proc Natl Acad Sci. (2016) 113:2625–30. 10.1073/pnas.1514699113
    1. Robertson TE, Sznycer D, Delton AW, Tooby J, Cosmides L. The true trigger of shame: social devaluation is sufficient, wrongdoing is unnecessary. Evol Hum Behav. (2018) 39:566–73. 10.1016/j.evolhumbehav.2018.05.010
    1. Hedman E, Ström P, Stünkel A, Mörtberg E. Shame and guilt in social anxiety disorder: effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PLoS ONE. (2013) 8:e61713. 10.1371/journal.pone.0061713
    1. Haberman A, Shahar B, Bar-Kalifa E, Zilcha-Mano S, Diamond GM. Exploring the process of change in emotion-focused therapy for social anxiety. Psychother Res. (2019) 29:908–18. 10.1080/10503307.2018
    1. Moscovitch DA. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cogn Behav Pract. (2009) 16:123–34. 10.1016/j.cbpra.2008.04.002
    1. Lazarus G, Shahar B. (2018). The role of shame and self-criticism in social anxiety: a daily diary study in a nonclinical sample. J Soc Clin Psychol. (2018) 37:107–27. 10.1521/jscp.2018.37.2.107
    1. Cândea DM, Szentágotai-Tătar A. Shame as a predictor of post-event rumination in social anxiety. Cogn Emot. (2017) 31:1684–91. 10.1080/02699931.2016.1243518
    1. Shahar B. Emotion focused therapy for the treatment of social anxiety: an overview of the model and a case description. Clin Psychol Psychother. (2014) 21:536–47. 10.1002/cpp.1853
    1. Brozovich F, Heimberg RG. An analysis of postevent processing in social anxiety disorder. Clin Psychol Rev. (2008) 28:891–903. 10.1016/j.cpr.2008.01.002
    1. Longe O, Maratos FA, Gilbert P, Evans G, Volker F, Rockliff H, et al. . Having a word with yourself: neural correlates of self-criticism and self-reassurance. Neuroimage. (2010) 49:1849–56. 10.1016/i.neuroimage.2009.09.019
    1. Anderson B, Goldin PR, Kurita K, Gross JJ. Self-representation in social anxiety disorder: linguistic analysis of autobiographical narratives. Behav Res Ther. (2008) 46:1119–25. 10.1016/j.brat.2008.07.00
    1. Makkar SR, Grisham JR. Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing. Behav Res Ther. (2011) 49:654–64. 10.1016/j.brat.2011.07.004
    1. Stopa L, Jenkins A. Images of the self in social anxiety: effects on the retrieval of autobiographical memories. J Behav Ther Exp Psychiatry. (2007) 38:459–73. 10.1016/j.jbtep.2007.08.006
    1. Matos M, Pinto-Gouveia J, Gilbert P. The effect of shame and shame memories on paranoid ideation and social anxiety. Clin Psychol Psychother. (2013) 20:334–49. 10.1002/cpp.1766
    1. Zoccola PM, Dickerson SS, Lam S. Eliciting and maintaining ruminative thought: the role of social-evaluative threat. Emotion. (2012) 12:673–7. 10.1037/a0027349
    1. Hofmann SG. Self-focused attention before and after treatment of social phobia. Behav Res Ther. (2000) 38:717–25. 10.1016/S0005-7967(99)00105-9
    1. Norton AR, Abbott MJ. Self-focused cognition in social anxiety: a review of the theoretical and empirical literature. Behav Change. (2015) 33:44–64. 10.1017/bec.2016.2
    1. Gregory B, Peters L. Changes in the self during cognitive behavioural therapy for social anxiety disorder: a systematic review. Clin Psychol Rev. (2017) 52:1–18. 10.1016/j.cpr.2016.11.008
    1. Kamboj SK, Kilford EJ, Minchin S, Moss A, Lawn W, Das RK, et al. . Recreational 3,4- methylenedioxy-N-methylamphetamine (MDMA) or ecstasy and self-focused compassion: preliminary steps in the development of a therapeutic psychopharmacology of contemplative practices. J Psychopharmacol. (2015) 29:961–70. 10.1177/0269881115587143
    1. Kamboj SK, Walldén YSE, Falconer CJ, Alotaibi MR, Blagbrough IS, Husbands SM. Additive effects of 3,4-methylenedioxymethamphetamine (MDMA) and compassionate imagery on self-compassion in recreational users of ecstasy. Mindfulness. (2018) 9:1134–45. 10.1007/s12671-017-0849-0
    1. Barone W, Beck J, Mitsunaga-Whitten M, Perl P. Perceived benefits of MDMA-assisted psychotherapy beyond symptom reduction: qualitative follow-up study of a clinical trial for individuals with treatment-resistant PTSD. J Psychoactive Drugs. (2019) 51:199–208. 10.1080/02791072.2019.1580805
    1. Werner KH, Jazaieri H, Goldin PR, Ziv M, Heimberg RG, Gross JJ. Self-compassion and social anxiety disorder. Anxiety Stress Coping. (2012) 25:543–58. 10.1080/10615806.2011.608842
    1. Makadi E, Koszycki D. Exploring connections between self-compassion, mindfulness, and social anxiety. Mindfulness. (2020) 11:480–92. 10.1007/s12671-019-01270-z
    1. Goetz JL, Keltner D, Simon-Thomas E. Compassion: an evolutionary analysis and empirical review. Psychol Bull. (2010) 136:351–74. 10.1037/a0018807
    1. Piff PK, Dietze P, Feinberg M, Stancato DM, Keltner D. Awe, the small self, and prosocial behavior. J Pers Soc Psychol. (2015) 108:883–99. 10.1037/pspi0000018
    1. Shiota MN, Keltner D, Mossman A. The nature of awe: elicitors, appraisals, and effects on self-concept. Cogn Emot. (2007) 21:944–63. 10.1080/02699930600923668
    1. Stellar JE, Gordon AM, Piff PK, Cordaro D, Anderson CL, Bai Y, et al. . Self- transcendent emotions and their social functions: compassion, gratitude, and awe bind us to others through prosociality. Emot Rev. (2017) 9:200–7. 10.1177/1754073916684557
    1. Hutcherson CA, Seppala EM, Gross JJ. Loving-kindness meditation increases social connectedness. Emotion. (2008) 8:720–4. 10.1037/a0013237
    1. Kok BE, Singer T. Effects of contemplative dyads on engagement and perceived social connectedness over 9 months of mental training a randomized clinical trial. JAMA Psychiatry. (2017) 74:126–34. 10.1001/jamapsychiatry.2016.3360
    1. Shahar B, Szsepsenwol O, Zilcha-Mano S, Haim N, Zamir O, Levi-Yeshuvi S, et al. . A wait-list randomized controlled trial of loving-kindness meditation programme for self-criticism. Clin Psychol Psychother. (2014) 22:346–56. 10.1002/cpp.1893
    1. Markey PM, Funder DG, Ozer DJ. Complementarity of interpersonal behaviors in dyadic interactions. Pers Soc Psychol Bull. (2003) 29:1082–90. 10.1177/0146167203253474
    1. Sadler P, Ethier N, Gunn GR, Duong D, Woody E. Are we on the same wavelength? Interpersonal complementarity as shared cyclical patterns during interactions. J Pers Soc Psychol. (2009) 97:1005–20. 10.1037/a0016232
    1. Hysek CM, Schmid Y, Simmler LD, Domes G, Heinrichs M, Eisenegger C, et al. . MDMA enhances emotional empathy and prosocial behavior. Soc Cogn Affect Neurosci. (2014) 9:1645–52. 10.1093/scan/nst161
    1. Luoma JB, Shahar B, Lear MK, Pilecki B, Wagner A. (Under Review). Potential Processes of Change in MDMA-Assisted Psychotherapy for Social Anxiety Disorder During Acute Dosing: Enhanced Memory Reconsolidation, Self-Transcendence, and Enhanced Therapeutic Relationship.
    1. Voncken MJ, Bögels SM. Social performance deficits in social anxiety disorder: reality during conversation and biased perception during speech. J Anxiety Disord. (2008) 22:1384–92. 10.1016/j.janxdis.2008.02.001
    1. Pearlstein SL, Taylor CT, Stein MB. Facial affect and interpersonal affiliation: displays of emotion during relationship formation in social anxiety disorder. Clin Psychol Sci. 7:826–39. 10.1177/2167702619825857
    1. Srivastava S, Tamir M, McGonigal KM, John OP, Gross JJ. The social costs of emotional suppression: a prospective study of the transition to college. J Pers Soc Psychol. (2009) 96:883–97. 10.1037/a0014755
    1. Hur J, Deyoung KA, Islam S, Anderson AS, Barstead MG, Shackman AJ. Social context and the real-world consequences of social anxiety. Psychol Med. (2020) 50:1989–2000. 10.1017/S0033291719002022
    1. Weeks JW, Heimberg RG, Heuer R. Exploring the role of behavioral submissiveness in social anxiety. J Soc Clin Psychol. (2011) 30:217–49. 10.1521/jscp.2011.30.3.217
    1. Zimmerman J, Morrison AS, Heimberg RG. Social anxiety, submissiveness, and shame in men and women: a moderated mediation analysis. Br J Clin Psychol. (2015) 54:1–15. 10.1111/bjc.12057
    1. Hirsch C, Meynen T, Clark D. Negative self-imagery in social anxiety contaminates social interactions. Memory. (2004) 12:496–506. 10.1080/09658210444000106
    1. Thompson S, Rapee RM. The effect of situational structure on the social performance of socially anxious and non-anxious participants. J Behav Ther Exp Psychiatry. (2002) 33:91–102. 10.1016/s0005-7916(02)00021-6
    1. Voncken MJ, Dijk KFL. Socially anxious individuals get a second chance after being disliked at first sight: the role of self-disclosure in the development of likeability in sequential social contact. Cognit Ther Res. (2013) 37:7–17. 10.1007/s10608-012-9449-4
    1. Blalock DV, Kashdan TB, McKnight PE. High risk, high reward: daily perceptions of social challenge and performance in social anxiety disorder. J Anxiety Disord. (2018) 54:57–64. 10.1016/j.janxdis.2018.01.006
    1. Mehu M, Little AC, Dunbar RM. duchenne smiles and the perception of generosity and sociability in faces. J Evol Psychol. (2007) 5:183–96. 10.1556/JEP.5.2007.1-4.11
    1. Woodzicka JA. (2008). Sex differences in self-awareness of smiling during a mock job interview. J Nonverbal Behav. (2008) 32:109–21. 10.1007/s10919-007-0046-2
    1. Cheng Y, Mukhopadhyay A, Williams P. Smiling signals intrinsic motivation. J Consum Res. (2020) 46:915–35. 10.1093/jcrucz023
    1. Heerey EA, Kring AM. Interpersonal consequences of social anxiety. J Abnorm Psychol. (2007) 116:125. 10.1037/0021-843X.116.1.125
    1. Dryman MT, Heimberg RG. Emotion regulation in social anxiety and depression: a systematic review of expressive suppression and cognitive reappraisal. Clin Psychol Rev. (2018) 65:17–42. 10.1016/j.cpr.2018.07.004
    1. Butler EA, Egloff B, Wlhelm FH, Smith NC, Erickson EA, Gross JJ. The social consequences of expressive suppression. Emotion. (2003) 3:48–67. 10.1037/1528-3542.3.1.48
    1. Schneider KG, Hempel RJ, Lynch TR. That “poker face” just might lose you the game! the impact of expressive suppression and mimicry on sensitivity to facial expressions of emotion. Emotion. (2013) 13:852–66. 10.1037/a0032847
    1. Tackman AM, Srivastava S. Social responses to expressive suppression: the role of personality judgments. J Pers Soc Psychol. (2016) 110:574–91. 10.1037/pspp0000053
    1. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. (2003) 85:348–62. 10.1037/0022-3514.85.2.348
    1. John OP, Gross JJ. Healthy and unhealthy emotion regulation: personality processes, individual differences, and life span development. J Pers. (2004) 72:1301–33. 10.1111/j.1467-6494.2004.00298.x
    1. Ryan WS, Ryan RM. Toward a social psychology of authenticity: exploring within- person variation in autonomy, congruence, and genuineness using self-determination theory. Rev Gen Psychol. (2019) 23:99–112. 10.1037/gpr0000162
    1. Lakey CE, Kernis MH, Heppner WL, Lance CE. Individual differences in authenticity and mindfulness as predictors of verbal defensiveness. J Res Pers. (2008) 42:230–8. 10.1016/j.jrp.2007.05.002
    1. Schlegel RJ, Hicks JA. The true self and psychological health: emerging evidence and future directions. Soc Personal Psychol Compass. (2011) 5:989–1003. 10.1111/j.1751-9004.2011.00401.x
    1. Wood AM, Linley PA, Maltby J, Baliousis M, Joseph S. The authentic personality: a theoretical and empirical conceptualization and the development of the authenticity scale. J Couns Psychol. (2008) 55:385–99. 10.1037/0022-0167.55.3.385
    1. Brunell AB, Kernis MH, Goldman BM, Heppner W, Davis P, Cascio EV, et al. . Dispositional authenticity and romantic relationship functioning. Pers Indiv Dif. (2010) 48:900–5. 10.1016/j.paid.2010.02.018
    1. Baker ZG, Tou RY, Bryan JL, Knee CR. Authenticity and well-being: exploring positivity and negativity in interactions as a mediator. Pers Individ Dif . (2017) 113:235–9. 10.1016/j.paid.2017.03.018
    1. Asher M, Aderka IM. How real do you feel? Self- and partner-authenticity in social anxiety disorder. J Abnorm Psychol. (2021) 130:166–76. 10.1037/abn0000622
    1. Orr EMJ, Moscovitch DA. Blending in at the cost of losing oneself: dishonest self- disclosure erodes self-concept clarity in social anxiety. J Exp Psychopathol. (2015) 6:278–96. 10.5127/jep.044914
    1. Rapee R, Spence S. The etiology of social phobia: empirical evidence and an initial model. Clin Psychol Rev. (2004) 24:737–67. 10.1016/j.cpr.2004.06.004
    1. Kearney CA. The etiology of social anxiety and social phobia in youths. In: Kearney CA. editor. Social Anxiety and Social Phobia in Youth: Characteristics, Assessment, and Psychological Treatment. New York, NY: Springer Publishing Co. (2005). p. 49–70.
    1. Kimbrel N. A model of the development and maintenance of generalized social phobia. Clin Psychol Rev. (2008) 28:592–612. 10.1016/j.cpr.2007.08.003
    1. Erwin BA, Heimberg RG, Marx BP, Franklin ME. Traumatic and socially stressful life events among persons with social anxiety disorder. J Anxiety Disord. (2006) 20:896–914. 10.1016/j.janxdis.2005.05.006
    1. Pinto-Gouveia J, Matos M. Can shame memories become a key to identity? The centrality of shame memories predicts psychopathology. Appl Cogn Psychol. (2011) 25:281–90. 10.1002/acp.1689
    1. Rosellini A, Rutter L, Bourgeois M, Emmert-Aronson B, Brown T. The relevance of age of onset to the psychopathology of social phobia. J Psychopathol Behav Assess. (2013) 35:356–65. 10.1007/s10862-013-9338-5
    1. Simon N, Herlands N, Marks E, Mancini C, Letamendi A, Zhonghe L, et al. . Childhood maltreatment linked to greater symptom severity and poorer quality of life and function in social anxiety disorder. Depress Anxiety. (2009) 26:1027–32. 10.1002/da.20604
    1. Heinrichs N, Rapee RM, Alden LA, Bögels SM, Hofmann SG, Oh KJ, et al. . Cultural differences in perceived social norms and society anxiety. Behav Res Ther. (2006) 44:1187–97. 10.1016/j.brat.2005.09.006
    1. Blöte A, Miers A, Westenberg P. The role of social performance and physical attractiveness in peer rejection of socially anxious adolescents. J Res Adolesc. (2015) 25:189–200. 10.1111/jora.12107
    1. Pabian S, Vandebosch H. An investigation of short-term longitudinal associations between social anxiety and victimization and perpetration of traditional bullying and cyberbullying. J Youth Adolesc. (2015) 45:328–39. 10.1007/s10964-015-0259-3
    1. Kiff CJ, Lengua LJ, Zalewski M. Nature and nurturing: parenting in the context of child temperament. Clin Child Fam Psychol Rev. (2011) 14:251–301. 10.1007/s10567-011-0093-4
    1. Rubin KH, Coplan RJ, Bowker JC. Social withdrawal in childhood. Annu Rev Psychol. (2009) 60:141–71. 10.1146/annurev.psych.60.110707.163642
    1. Alden LE, Taylor CT. Relational treatment strategies increase social approach behaviors in patients with generalized social anxiety disorder. J Anxiety Disord. (2011) 25:309–18. 10.1016/j.janxdis.2010.10.003
    1. Fogler JM, Tompson MC, Steketee G, Hofmann SG. Influence of expressed emotion and perceived criticism on cognitive-behavioral therapy for social phobia. Behav Res Ther. (2007) 45:235–49. 10.1016/j.brat.2006.03.002
    1. Baggott MJ, Coyle JR, Siegrist JD, Garrison KJ, Galloway GP, Mendelson JE. Effects of 3,4-Methylenedioxymethamphetamine on socioemotional feelings, authenticity, and autobiographical disclosure in healthy volunteers in a controlled setting. J Psychopharmacol. (2016) 30:378–87. 10.1177/0269881115626348
    1. Davidson JRT. Pharmacotherapy of social phobia. Acta Psychiatr Scand Suppl. (2003) 65–71. 10.1034/j.1600-0447.108.s417.7.x

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