New Gambling Task Reveals an Atypical Relation Between Social Anxiety and Social Avoidance in Schizophrenia

A core symptom of schizophrenia is a deficit in social cognition. Furthermore, many patients suffer from relevant social anxiety. How social anxiety relates to social avoidance in schizophrenia is, however, still unclear. To address this question empirically, 30 participants with schizophrenia were compared to individually matched controls in a recently developed experimental task. In each trial, participants chose between a monetary gamble with a human partner providing social feedback and a defined monetary amount that varied across trials. The tendency to avoid the interaction under acceptance of monetary loss served as a measure of social avoidance. Patients showed higher levels of social anxiety assessed using the Liebowitz Social Anxiety Scale (LSAS) than controls, took longer to decide whether to engage in the social interaction and rated social feedback as less intense. Despite making rational decisions, patients surprisingly showed no social avoidance. We assume that the lack of experimentally induced social avoidance in contrast to the well-known social avoidance behavior in everyday life, also reflected by elevated self-rated LSAS scores, was due to a partial compensation of delayed social information processing in the absence of the time constraints in our task. This additional time may have allowed rational decisions and masked potential social avoidance behavior. We conclude that social anxiety in schizophrenia may have different characteristics than in individuals without schizophrenia, namely avoidance of negative feedback caused by prolonged social processing instead of fear of supposed negative feedback. Treatment strategies for social anxiety in schizophrenia may benefit from considering these differences.