Facial expressions and eye tracking in individuals with social anxiety disorder: a systematic review

Claudino, Rianne Gomes e; Lima, Laysa Karen Soares de; Assis, Erickson Duarte Bonifácio de; Torro, Nelson

doi:10.1186/s41155-019-0121-8

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Psychological process and experimental psychology, Review • Psicol. Reflex. Crit. 32 • 2019 • https://doi.org/10.1186/s41155-019-0121-8 copy

Facial expressions and eye tracking in individuals with social anxiety disorder: a systematic review

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Abstract

Social anxiety disorder (SAD) is characterized by the fear of being judged negatively in social situations. Eye-tracking techniques have been prominent among the methods used in recent decades to investigate emotional processing in SAD. This study offers a systematic review of studies on eye-tracking patterns in individuals with SAD and controls in facial emotion recognition tasks. Thirteen articles were selected from the consulted databases. It was observed that the subjects with SAD exhibited hypervigilance-avoidance in response to emotions, primarily in the case of negative expressions. There was avoidance of conspicuous areas of the face, particularly the eyes, during observations of negative expressions. However, this hypervigilance did not occur if the stimulus was presented in virtual reality. An important limitation of these studies is that they use only static expressions, which can reduce the ecological validity of the results.

Keywords:
Social phobia; Facial expressions; Eye tracking; Eye movements

Authors	Sample	Apparatus	Type of stimuli	Emotions	Method	Time	Main results
Horley et al. (2003)Horley, K., Williams, L. M., Gonsalvez, C., & Gordon, E. (2003). Social phobics do not see eye to eye: A visual scanpath study of emotional expression processing. Anxiety Disorders, 17, 33–44. https://doi.org/10.1016/s0887-6185(02)00180-9. https://doi.org/10.1016/s0887-6185(02)00...	Clinical SAD patients (n = 15); controls (n = 15)	CEDRIC Mark II	Photographs	Neutral, happy, and sadness	Required to look at the fixation point for 1 s, just until the face appeared. Afterward, could freely look at the face	10 s	Subjects with SAD: Lack of fixation for sadness and neutral; greater tracking length; tendency to avoid fixation on eyes, nose, and mouth; avoidance of eyes on sad faces
Horley et al. (2004)Horley, K., Williams, L. M., Gonsalvez, C., & Gordon, E. (2004). Face to face: Visual scanpath evidence for abnormal processing of facial expressions in social phobia. Psychiatry Research, 127, 43–53. https://doi.org/10.1016/j.psychres.2004.02.016. https://doi.org/10.1016/j.psychres.2004....	Clinical SAD patients (n = 22); controls (n = 22)	CEDRIC Mark II	Photographs	Happy, sadness, anger, and neutral	Looked freely at faces	10 s	Subjects with SAD: Hypervigilance and avoidance of eyes in the case of anger
Garner et al. (2006)Garner, M., Mogg, K., & Bradley, B. P. (2006). Orienting and maintenance of gaze to facial expressions in social anxiety. Journal of Abnormal Psychology, 115(4), 760–770. https://doi.org/10.1037/0021-843x.115.4.760. https://doi.org/10.1037/0021-843x.115.4....	Exp. 1: (n = 40) students (control and SAD); Exp. 2: (n = 40) students (control and SAD)	Eye Tracker and Gaze Tracker, Applied Science Laboratories, Model 504	Photographs of faces and domestic objects (e.g., chair, lamp, clock)	Neutral, happy, and anger	Exp. 1: Pair of images (neutral-emotion or neutral-object), subsequently replaced by two points (vertical or horizontal) in the position of one of the faces. Required to indicate the orientation of the points Exp. 2: Before Task 1 were instructed to present a speech to a camera	1.5 s	Exp. 1: Subjects with SAD: First fixation and maintenance in the case of emotional faces; longer fixation time on neutral faces than on objects Exp. 2: Subjects with SAD: Shorter fixation latency for emotional faces but with shorter fixation time Both groups: Fixation first and gaze maintained for longer for faces as opposed to objects
Mühlberger et al. (2008)Mühlberger, A., Weiser, M. J., & Pauli, P. (2008). Visual attention during virtual social situations depends on social anxiety. Cyberpsychol Behavior, 11 (4), 425–430. https://doi.org/10.1089/cpb.2007.0084. https://doi.org/10.1089/cpb.2007.0084...	SAD students (n = 12); controls (n = 14)	iView X Hi-Speed, SMI	Virtual environments with elevator, person, or virtual object (e.g., bookcase)	Anger and happy	In an elevator with opening doors (on 60 floors) pairs of stimuli (two people with different expressions, one happy person and a bookcase, one angry person and a bookcase) were presented	6 s	Subjects with SAD: Initially avoided the faces and avoided maintaining fixation on angry faces
Weiser et al. (2009b)Weiser, M. J., Pauli, P., Weyers, P., Alpers, G. W., & Mühlberger, A. (2009b). Fear of negative evaluation and the hypervigilance-avoidance hypothesis: An eye-tracking study. Journal of Neural Transmission, 116, 717–723. https://doi.org/10.1007/s00702-008-0101-0. https://doi.org/10.1007/s00702-008-0101-...	n = 29 female students (separated into 2 groups)	iView X Hi-Speed, SMI	Virtual photographs	Happy, anger, and neutral	Explored a pair of faces (neutral-emotion). Afterward, judged the valence and arousal of the face	3 s	Subjects with SAD: Hypervigilance in the first fixation in the case of emotions; attentional bias toward happy female faces; modest hypervigilance-avoidance regarding emotions
Weiser et al. (2009a)Weiser, M. J., Pauli, P., & Mühlberger, A. (2009a). Probing the attentional control theory in social anxiety: An emotional saccade task. Cognitive, Affective, & Behavioral Neuroscience, 9(3), 314–322. https://doi.org/10.3758/cabn.93.314. https://doi.org/10.3758/cabn.93.314...	Students with high levels of SAD (n = 21); low levels of SAD (n = 21); controls (n = 20)	iView X Hi-Speed, SMI	Virtual photographs	Happy, anger, sadness, fear, and neutral	Faces presented at the sides of the screen. Required to perform prosaccades or antisaccades toward the faces, then judge the valence and arousal of the face	1 s	Subjects with SAD: Antisaccades with more errors in response to all facial expressions Both groups: Correct antisaccades with more time in response to fearful faces
Moukheiber et al. (2010)Moukheiber, A., Rautureau, G., Perez-Diaz, F., Soussignan, R., Dubal, S., Jouvent, R., et al. (2010). Gaze avoidance in social phobia: Objective measure and correlates. Behaviour Research and Therapy, 48, 147–151. https://doi.org/10.1016/j.brat.2009.09.012. https://doi.org/10.1016/j.brat.2009.09.0...	SAD patients (n = 26); control (n = 24)	EyeLink II	Male and female photographs	Happy, surprise, disgust, sadness, anger, fear, and neutral	There was no participant task; subjects were required to hold the head still and, after cross-calibration in the middle of the screen between the pictures, to look at the pictures	10 s	Subjects with SAD: Hyperscanning overview and a reduction in fixations and time for the eye region and to specific emotions, most notably anger and disgust. No difference was observed in relation to gaze avoidance according to the correspondence of the sex of the subject and that of the image
Lange et al. (2011)Lange, W. G., Heuer, K., Langner, O., Keijsers, G. P. J., Becker, E. S., & Rinck, M. (2011). Face value: Eye movements and the evaluation of facial crowds in social anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 42, 355–363. https://doi.org/10.1016/j.jbtep.2011.02.007. https://doi.org/10.1016/j.jbtep.2011.02....	SAD students (n = 22); controls (n = 21)	EyeLink V02.01	Photographs	Anger, neutral, and happy	Explore matrices of neutral-angry or happy-angry faces. Had to judge the matrices as friendly or not	500 ms or 2.5 s	Subjects with SAD: Fixation on angry faces. Long presentation time: Quicker deviation if the original fixation was toward anger
Schofield et al. (2013)Schofield, C. A., Inhoff, A. W., & Coles, M. E. (2013). Time-course of attention biases in social phobia. Journal of Anxiety Disorders, 27, 661–669. https://doi.org/10.1016/j.janxdis.2013.07.006. https://doi.org/10.1016/j.janxdis.2013.0...	Clinical SAD patients (n = 19); controls (n = 20)	EyeLink 1000 - SR Research	Photographs	Happy, fear, anger, and neutral	Pairs of facial expressions (anger-neutral, fear-neutral, happy-neutral) replaced by a down or up arrow in the position of one of the faces. Required to indicate the arrow type	1.5 s	Subjects with SAD: Similar fixation pattern toward emotion and neutral Controls: More fixation toward happy in the last moments of the presentation and less throughout the presentation in relation to negative emotions Two groups: Lower fixation latency for emotional faces
Finch et al. (2016)Finch, E. C., Iverach, L., Menzies, R. G., & Jones, M. (2016). Terror mismanagement: Evidence that mortality salience exacerbates attentional bias in social anxiety. Cognition and Emotion, 30(7), 1370–1379. https://doi.org/10.1080/02699931.2015.1065794. https://doi.org/10.1080/02699931.2015.10...	SAD students (n = 36); controls (n = 37)	Tobii T120 eye-tracking system	Photographs	Anger, neutral, and happy	Looked at pairs of facial expressions for 3000 ms in two stages: during the first 500 ms of exposure and during the remaining time	3 s	Subjects with SAD: Initial bias toward social threat. In particular, socially anxious participants in the fear of death condition were vigilant in the detection of angry and happy faces
Boll et al. (2016)Boll, S., Bartholomaeus, M., Peter, U., Lupke, U., & Gamer, M. (2016). Attentional mechanisms of social perception are biased in social phobia. Journal of Anxiety Disorders, 40, 83–93. https://doi.org/10.1016/j.janxdis.2016.04.004. https://doi.org/10.1016/j.janxdis.2016.0...	Clinical SAD patients (n = 22); controls (n = 22)	EyeLink 1000	Grayscale photographs	Anger, fear, happy, and neutral	Exp 1: Rated the emotion of facial stimuli as quickly and accurately as possible Exp 2: Identified the target letter presented next to the facial stimuli as quickly and accurately as possible	150 ms or 3 s	Exp 1: Patients with SAD: Hypervigilance in relation to the mouth area regardless of the type of emotional expression. There was no evidence of subsequent avoidance of looking toward the eye. Time difference in looking toward the eye between patients and controls. Exp 2: Patients with SAD were significantly slower than controls in identifying the target letter, but there was no significant difference with respect to the number of correct responses when identifying letters
Kim and Lee (2016)Kim, D. H., & Lee, J. H. (2016). A preliminary study on the biased attention and interpretation in the recognition of face-body compound of the individuals with social anxiety. Frontiers In Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00414. https://doi.org/10.3389/fpsyg.2016.00414...	SAD students (n = 22); controls (n = 22)	iView X RED-IV, SMI	Face-body composites: consistent (same emotion) and inconsistent (different emotion)	Anger, fear, disgust, sadness, and happy	Looked at the picture and selected the emotional state that best described the presented individual	4 s	Individuals with SAD: Hypervigilance without avoidance toward the face for consistent composite face and body images. There was an avoidance of faces without hypervigilance
Lazarov et al. (2016)Lazarov, A., Abend, R., & Bar-Haim, Y. (2016). Social anxiety is related to increased dwell time on socially threatening faces. Journal of Affective Disorders, 193, 282–288. https://doi.org/10.1016/j.jad.2016.01.007. https://doi.org/10.1016/j.jad.2016.01.00...	Students with low levels of SAD (n = 20); students with high levels of SAD (n = 20); clinical SAD patients (n = 20)	SMI BeGaze native software	Color photographs of 16 male and 16 female actors	Unpleasant and neutral expressions	Looked freely at each matrix in any way desired until it disappeared. Student groups repeated the session after 1 week	6 s	Session 1: All groups spent less fixation time on threatening faces than neutral faces. High SAD and clinical patient group: The fixation time was greater on threat than the low SAD group Session 2: High SAD group exhibited more fixation time on threat than the low SAD group. No significant difference was found in fixation time on neutral faces

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[1] * Correspondence: riannegclaudino@hotmail.com

PubMed	(“social anxiety” OR “social phobia”) [Title/Abstract] AND (“eye tracker” OR “eye tracking” OR “eye movements” OR “eye gaze” [Title/Abstract]) AND (“emotional face” OR “emotion” OR “face” OR “facial expression” OR “facial emotion” OR “facial” OR “emotional facial expression” [Title/Abstract])
Web of Science	(TI = (social anxiety OR social phobia) AND TI = (eye tracker OR eye tracking OR eye movements OR eye gaze) AND TI = (emotional face OR emotion OR face OR facial expression OR facial emotion OR facial OR emotional facial expression))
Scopus	TITLE-ABS-KEY(“anxiety” OR “social phobia”) AND TITLE-ABS-KEY(“eye tracker” OR “eye tracking” OR “eye movements” OR “eye gaze”) AND TITLE-ABS-KEY(“emotional face” OR “emotion” OR “face” OR “facial expression” OR “facial emotion” OR “facial” OR “emotional facial expression”)
EBSCO	(AB “social anxiety OR social phobia”) AND (AB “eye tracker OR eye tracking OR eye movements OR eye gaze”) AND (AB “emotional face OR emotion OR face OR facial expression OR facial emotion OR facial OR emotional facial expression”)
ScienceDirect	(“social anxiety” OR “social phobia”) AND (“eye tracker” OR “eye tracking” OR “eye movements” OR “eye gaze”) AND (“emotional face” OR “emotion” OR “face” OR “facial expression” OR “facial emotion” OR “facial” OR “emotional facial expression”)
MEDLINE	Tw:(social anxiety OR social phobia AND eye tracker OR eye tracking OR eye movements OR eye gaze AND emotional face OR emotion OR face OR facial expression OR facial emotion OR facial OR emotional facial expression)