Social anxiety and the positive valence system: A scoping review

Social anxiety disorder (SAD) is defined by negative valence symptoms, such as fear and anxiety related to perceived social threats, however, a growing literature has also identified positive valence system (PVS) impairments. PVS deficits in approach motivation, positive affect, and reward sensitivity may contribute to limitations in efficacy of existing treatments that primarily target negative valence system features. This scoping review describes the literature assessing PVS-targeted treatments of SAD and associations of PVS measures with social anxiety (SA) or SAD across units of analysis, from self-report to neuroimaging. Following screening, 192 peer-reviewed articles were included. Findings were most robust for association of SA and SAD with lower self-reported positive affect and reward sensitivity. Studies utilizing reward tasks reported some divergence of outcomes, with SA and SAD being associated with greater behavioral and striatal reactivity to social and monetary rewards in youth, but decreased reactivity specific to social rewards in adults. Some studies of reward learning found an association of SAD and SA with deficits in learning from and recalling social rewards, though neural outcomes were mixed. Most studies of novel PVS-focused treatments have used nonsocial rewards to motivate behavioral change, with fewer studies exploring direct enhancement of PVS functions. Inconsistencies in findings may relate to small sample sizes and heterogeneous methods. Further clarification of behavioral and neural mechanisms of PVS deficits is needed, but existing evidence supports increased development and testing of treatments to leverage and enhance PVS function in SAD.