Background and objectives Much of our current understanding of social anxiety rests on the use of highly restricted laboratory experiments. Latest technological developments now allow the investigation of eye movements and physiological measures during real social interactions. Considering the wealth of conflicting findings on gaze behavior in social anxiety, the current study aimed at elucidating the modulation of gaze patterns in a naturalistic setting. Methods We introduced 71 participants with differing social anxiety symptoms to a waiting room situation while recording heart rate, electrodermal activity and eye movements using mobile technology. Results We observed fewer fixations on the head of the confederate in the initial waiting phase of the experiment. These head fixations increased when the confederate was involved in a phone call and subsequently initiated an actual conversation. Contrary to gaze-avoidance models of social anxiety, we did not observe any correlations between social anxiety and visual attention but an elevated heart rate in participants with high social anxiety. Limitations Although social anxiety varied considerably in the current sample and reached clinically relevant levels in one third of participants, formal clinical diagnoses were not available. Conclusions The current findings suggest that gaze avoidance might only occur in specific situations or very high levels of social anxiety. Fear of eye contact could at times represent a subjectively experienced rather than an objectively measurable feature of the disorder. The observation of elevated heart rate throughout the entire experiment indicates that physiological hyperactivity might constitute a cardinal feature of social anxiety.

Much of our current understanding of social anxiety rests on the use of simplistic stimulation material in laboratory settings. Latest technological developments now allow the investigation of eye movements and physiological measures during real interactions with adequate recording quality. Considering the wealth of conflicting findings on gaze behavior in social anxiety, the current study aimed at unraveling the mechanisms contributing to differential gaze patterns in a naturalistic setting in the general population and in social anxiety. We introduced participants with differing social anxiety symptoms to a waiting room situation while recording heart rate and electrodermal activity using mobile sensors and eye movements using mobile eye-tracking glasses. We observed fewer fixations on the head of the confederate in the initial waiting phase of the experiment. These head fixations increased when the confederate was involved in a phone call and head fixations were most pronounced during the actual conversation. In opposition to gaze-avoidance models of social anxiety, we did not observe any correlations between social anxiety and visual attention. Social anxiety was, however, associated with elevated heart rate throughout the entire experiment suggesting that physiological hyperactivity constitutes a cardinal feature of the disorder.