Improving Emotion Control in Social Anxiety by Targeting Rhythmic Brain Circuits

Abstract

Social avoidance is a hallmark of social anxiety disorder. Difficulties in controlling avoidance behavior are the core maintaining factor of this impairing condition, hampering the efficacy of existing therapies. This preregistered study tested a physiologically grounded noninvasive enhancement of control over social approach and avoidance behavior in socially anxious individuals. Participants received dual-site phase-coupled electrical stimulation aimed at enhancing endogenous interregional theta-gamma phase-amplitude coupling between prefrontal and sensorimotor cortex, a mechanism known to support emotional action control in nonanxious individuals. We measured behavioral and fMRI BOLD responses during in-phase, anti-phase, and sham stimulations, while participants of either sex performed a social approach-avoidance task, involving either automatic or controlled emotional actions. In-phase stimulation selectively enhanced control over approach-avoidance actions. Notably, in-phase stimulation modulated neural responses in the same prefrontal region where target engagement increased as a function of trait anxiety. These findings illustrate how human neurophysiological connectivity can be leveraged to improve control over social avoidance, opening the way for mechanistically grounded clinical interventions of persistent avoidance in anxiety disorders.