title: Anticipation of public speaking in virtual reality reveals a relationship between trait social anxiety and startle reactivity.
abstract: BACKGROUND
  Startle reflex modification has become valuable to the study of fear and anxiety, but few studies have explored startle reactivity in socially threatening situations.
  
  
  METHODS
  Healthy participants ranging in trait social anxiety entered virtual reality (VR) that simulates standing center-stage in front of an audience to anticipate giving a speech and count backward. We measured startle and autonomic reactivity during anticipation of both tasks inside VR after a single baseline recording outside VR.
  
  
  RESULTS
  Trait social anxiety, but not general trait anxiety, was positively correlated with startle before entering VR and most clearly during speech anticipation inside VR. Speech anticipation inside VR also elicited stronger physiologic responses relative to anticipation of counting.
  
  
  CONCLUSIONS
  Under social-evaluative threat, startle reactivity showed robust relationships with fear of negative evaluation, a central aspect of social anxiety and clinical social phobia. Context-specific startle modification may be an endophenotype for subtypes of pathological anxiety.
authors.affiliation: Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland 20895, USA. cornwellb@mail.nih.gov
authors.forename: Brian R
authors.initials: BR
authors.lastname: Cornwell
authors.forename: Linda
authors.initials: L
authors.lastname: Johnson
authors.forename: Luciano
authors.initials: L
authors.lastname: Berardi
authors.forename: Christian
authors.initials: C
authors.lastname: Grillon
mesh_terms: D000328:Adult; D001290:Attitude; D005239:Fear; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000523:psychology*; D013216:Reflex, Startle / Q000502:physiology*; D013060:Speech; D014584:User-Computer Interface