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Development of a Paradigm for Examining Social Exclusion in Schizophrenia: Dissociating Expectancy Violations from Social Distress

Abstract

Despite the well-established finding that psychosocial stressors influence symptom onset and clinical relapse in patients with schizophrenia, less is known about how these stressors influence such changes in schizophrenia and why only a subset of patients relapse. Stress elicited by social evaluative threat (SET) may provide a mechanism by which psychosocial stressors influence symptoms and relapse. The present study sought to develop a modified Cyberball paradigm to examine social exclusion, a type of SET, in patients in an effort to understand how sensitivity to SET impacts symptoms and relapse. Additionally, there is controversy regarding the functional significance of the activation of the dorsal anterior cingulate cortex (dACC) region of the brain during the Cyberball task, with some studies implicating dACC in detecting violations of expectancy and other studies implicating dACC in responding to social distress and negative affect. The present examination evaluated the functional significance of exclusion-related neural activity during the task. Electroencephalogram (EEG) data were recorded while 32 healthy participants completed a modified Cyberball paradigm. EEG data were fit to a source model with six regional sources, including dACC and anterior insula (AI). Participants self-reported similar levels of social distress to those reported in prior Cyberball studies, suggesting that the social exclusion manipulation was successful. Present findings provided evidence that early dACC activity is sensitive to violations of expectancy and that late dACC activity is sensitive to changes in negative affect. Bilateral AI activity was greater during the first block of the exclusion phase than during the inclusion phase and positively correlated with measures of social distress, supporting previous research implicating AI in responding to changes in social distress following exclusion. By identifying the functional significance of scalp- and source-space activity during a modified Cyberball task, these findings lay the groundwork for examining SET in patients with schizophrenia. This study capitalized on the temporal resolution of EEG in order to identify the functional significance of early and late dACC activity and provided evidence that the functional significance of dACC is not fully accounted for by either expectancy violations or social distress and negative affect alone.

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