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Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2020,2,25]]},"abstract":"<jats:p>Social-anxiety disorder involves a fear of embarrassing oneself in the presence of others. Taijin-kyofusho (TKS), a subtype common in East Asia, additionally includes a fear of embarrassing others. TKS individuals are hypersensitive to others\u2019 feelings and worry that their physical or behavioral defects humiliate others. To explore the underlying neurocognitive mechanisms, we compared TKS ratings with questionnaire-based empathic disposition, cognitive flexibility (set-shifting), and empathy-associated brain activity in 23 Japanese adults. During 3-tesla functional MRI, subjects watched video clips of badly singing people who expressed either authentic embarrassment (EMBAR) or hubristic pride (PRIDE). We expected the EMBAR singers to embarrass the viewers via emotion-sharing involving affective empathy (affEMP), and the PRIDE singers to embarrass via perspective-taking involving cognitive empathy (cogEMP). During affEMP (EMBAR &gt; PRIDE), TKS scores correlated positively with dispositional affEMP (personal-distress dimension) and with amygdala activity. During cogEMP (EMBAR &lt; PRIDE), TKS scores correlated negatively with cognitive flexibility and with activity of the posterior superior temporal sulcus\/temporoparietal junction (pSTS\/TPJ). Intersubject correlation analysis implied stronger involvement of the anterior insula, inferior frontal gyrus, and premotor cortex during affEMP than cogEMP and stronger involvement of the medial prefrontal cortex, posterior cingulate cortex, and pSTS\/TPJ during cogEMP than affEMP. During cogEMP, the whole-brain functional connectivity was weaker the higher the TKS scores. The observed imbalance between affEMP and cogEMP, and the disruption of functional brain connectivity, likely deteriorate cognitive processing during embarrassing situations in persons who suffer from other-oriented social anxiety dominated by empathic embarrassment.<\/jats:p>","DOI":"10.1073\/pnas.1918081117","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T20:25:51Z","timestamp":1581366351000},"page":"4385-4391","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":43,"title":["Brain and behavioral alterations in subjects with social anxiety dominated by empathic embarrassment"],"prefix":"10.1073","volume":"117","author":[{"given":"Shisei","family":"Tei","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medicine, Kyoto University, 606-8507 Kyoto, Japan;"},{"name":"School of Human and Social Sciences, Tokyo International University, 350-1198 Saitama, Japan;"},{"name":"Institute of Applied Brain Sciences, Waseda University, 359-1192 Saitama, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka-Pekka","family":"Kauppi","sequence":"additional","affiliation":[{"name":"Faculty of Information Technology, University of Jyv\u00e4skyl\u00e4, FI-40014 Jyv\u00e4skyl\u00e4, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn F.","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Oregon, Eugene, OR 97403;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Fujino","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medicine, Kyoto University, 606-8507 Kyoto, Japan;"},{"name":"Medical Institute of Developmental Disabilities Research, Showa University, 157-8577 Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo P.","family":"Monti","sequence":"additional","affiliation":[{"name":"Gatsby Computational Neuroscience Unit, University College London, W1T 4JG London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jussi","family":"Tohka","sequence":"additional","affiliation":[{"name":"AI Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhito","family":"Abe","sequence":"additional","affiliation":[{"name":"Kokoro Research Center, Kyoto University, 606-8507 Kyoto, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiya","family":"Murai","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medicine, Kyoto University, 606-8507 Kyoto, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidehiko","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medicine, Kyoto University, 606-8507 Kyoto, Japan;"},{"name":"Department of Psychiatry and Behavioral Sciences, Tokyo Medical and Dental University, 113-8510 Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3142-2703","authenticated-orcid":false,"given":"Riitta","family":"Hari","sequence":"additional","affiliation":[{"name":"Department of Art, School of Arts, Design and Architecture, Aalto University, FI-00076 Espoo, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1017\/S1121189X00001421","article-title":"The global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys","volume":"18","author":"Kessler R. 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