The widening of the gaze cone in patients with social anxiety disorder and its normalization after CBT

Gaze plays a crucial role in social interactions. Social Anxiety Disorder (SAD), which is associated with severe impairment of social interactions, is thus likely to exhibit disturbances of gaze perception. We conducted two experiments with SAD-patients and healthy control participants using a virtual head whose gaze could be interactively manipulated. We determined the subjective area of mutual gaze, the so-called gaze cone, and measured it prior to and after a psychotherapeutic intervention (Exp. 1). Patients exhibited larger gaze cones than control subjects. Exp. 2 varied the emotional expression of the virtual head. These data were validated using a real person (professional actor) as stimulus. Excellent reliability indices were found for our gaze cone measure. After Cognitive Behavioral Therapy, group differences in gaze cone width had disappeared. Emotional expressions were observed to modulate the gaze cone's width. Especially an angry expression caused the gaze cone to widen, possibly mediated by increased arousal. Finally, wider gaze cones in SAD-patients could be demonstrated for virtual and for real human heads confirming the ecological validity of virtual heads. The findings are of relevance for a more fine-grained understanding of perceptual processes in patients with SAD.