3 69 Looking into troubled waters: Childhood emotional maltreatment modulates neural responses to prolonged gazing into one’s own, but not others’, eyes DISCUSSION This study shows that people who report moderate to extreme levels of CEM show enhanced vmPFC responses to one’s own direct gaze, but not to the gaze of a stranger. CEM’s effects on mood generalized to eye contact with other people, showing that CEM was not only associated with lower mood after directly gazing into one’s own eyes, but also after gazing into another person’s eyes. CEM was not associated with participants’ gaze responses into one’s own eyes or the eyes of a stranger in neither of the gaze directions. Increased vmPFC activity in response to participants’ own direct gaze fits into a larger literature robustly linking vmPFC activity to affective aspects of self-evaluation (Moran et al., 2006; Northoff et al., 2006; Talmon et al., 2021; van der Meer et al., 2010; Will et al., 2020; Will et al., 2017). Given the vmPFCs general role in emotion-regulation and representing subjective value, increased vmPFC activity in participants reporting CEM might indicate an increased engagement of self-related emotion-regulation processes in response to their own direct gaze. As such, vmPFC hyperactivation might signal a potential neural phenotype related to (maladaptive) patterns of increased self-referential processing associated with CEM that is activated when being confronted with one’s own gaze. This is in line with a study of Talmon et al. (2021) who found enhanced default mode network activation, including the same vmPFC region, in people diagnosed with social anxiety disorder and who reported to have a history of CEM. Interestingly, they did not find this effect in people diagnosed with social anxiety disorder without a history of CEM. Hyperactivation in a similar area of the vmPFC [MNI-coordinate: 10, 44, -7] was also found in depressed patients (versus healthy controls) in response to judgements about whether or not personality traits described themselves (Yoshimura et al., 2010), in particular for negative traits. The overlap between the clusters found in patients with social anxiety disorder and depression, and the cluster co-varying with CEM in our sample suggests that this region may be involved in negative self-attributions, either explicitly or in a more implicit manner (i.e., when looking at the self). The associations between CEM and vmPFC activation did not remain significant when controlling for participants’ depression- and anxiety severity, psychotropic medication status, or self-esteem. As indicated by their individual correlations, these variables show an association with CEM, but are not directly related with vmPFC activation. Therefore, CEM seems to be uniquely associated with participants’ neural response to one’s own direct gaze. While people reporting less or no CEM showed a higher mood in response to direct versus averted gaze, this was not the case for individuals reporting more CEM, suggesting that people with more CEM do not benefit as much from the mood-boosting effects of making eye contact as people who reported less or no CEM. We found no evidence of CEM specifically moderating mood responses to videos of the self versus others. This is in contrast with participants’ neural responses, which showed a unique association of CEM on self-related, but not other-related
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