The Impact of Social Anxiety Disorder on Emotional Expression Recognition: A Meta-analysis

Background Impaired processing of emotional expression recognition (EER) has been theorized to be a maintaining factor of social anxiety disorder (SAD). However, the evidence suggesting a decreased ability to recognize emotional facial expressions in this population is mixed. Methods We performed a systematic review and meta-analysis investigating the relationship between SAD and EER. We included English peer-reviewed full-text articles with (1) a primary diagnosis of SAD, (2) an EER task using a validated face database, and (3) accuracy and/or reaction time as outcome measures. Risk of Bias was assessed using the RoBANS, and results were synthesized using Comprehensive Meta-Analysis. The literature search took place between April 17, 2020 and January 26, 2022. Sixteen articles (N = 788) were selected from a search of six databases. EER was assessed through accuracy and reaction time, with stimulus duration and comorbidity considered as moderators. Results Our results indicate that individuals with SAD may have difficulty recognizing emotional expressions overall, and when presenting with a comorbidity demonstrate poorer performance at recognizing happy facial expressions. Individuals with SAD also take a greater amount of time to recognize happy facial expressions. Conclusion Our results suggest that individuals with SAD demonstrate poorer performance in accurately recognizing various expressions, such as happy facial expressions. Given the narrow aim of this study, some results are underpowered.