Anterior cingulate cortex and insula response during indirect and direct processing of emotional faces in generalized social anxiety disorder

Abstract

BackgroundGeneralized social anxiety disorder (gSAD) is associated with a heightened neural sensitivity to signals that convey threat, as evidenced by exaggerated amygdala and/or insula activation when processing face stimuli that express negative emotions. Less clear in the brain pathophysiology of gSAD are cortical top down control mechanisms that moderate reactivity in these subcortical emotion processing regions. This study evaluated amygdala, insula, and anterior cingulate cortex (ACC) activity in gSAD with a novel “Emotional Faces Shifting Attention Task” (EFSAT), an adaptation of perceptual assessment tasks well-known to elicit amygdala response. In healthy volunteers, the task has been shown to engage the amygdala when attention is directed to emotional faces and the ACC when attention is directed to shapes, away from emotional faces.MethodsDuring functional MRI, 29 participants with gSAD and 27 healthy controls viewed images comprising a trio of faces (angry, fear, or happy) alongside a trio of geometric shapes (circles, rectangles, or triangles) within the same field of view. Participants were instructed to match faces or match shapes, effectively directing attention towards or away from emotional information, respectively.ResultsParticipants with gSAD exhibited greater insula, but not amygdala, activation compared to controls when attending to emotional faces. In contrast, when attention was directed away from faces, controls exhibited ACC recruitment, which was not evident in gSAD. Across participants, greater ACC activation was associated with less insula activation.ConclusionsEvidence that individuals with gSAD exhibited exaggerated insula reactivity when attending to emotional faces in EFSAT is consistent with other studies suggesting that the neural basis of gSAD may involve insula hyper-reactivity. Furthermore, greater ACC response in controls than gSAD when sustained goal-directed attention is required to shift attention away from social signals, together with a negative relationship between ACC and bilateral insula activity, indicate the ACC may have served a regulatory role when the focus of attention was directed to shapes amidst emotional faces.

Common and distinct neural correlates of facial emotion processing in social anxiety disorder and Williams syndrome: A systematic review and voxel-based meta-analysis of functional resonance imaging studies

“…Accumulating data also point to insula hyper-reactivity in regard to processing negative emotional information in SAD (Amir et al, 2005;Gentili et al, 2008;Klumpp et al, 2010Klumpp et al, , 2012Klumpp et al, , 2013Straube et al, 2004Straube et al, , 2005Yoon et al, 2007), and evidence of a correlation between anterior insula reactivity to threat relevant cues and symptom severity (Klumpp et al, 2013;Ziv et al, 2013) also supports this notion. Moreover, some data suggest that exaggerated insula reactivity may relate to a deficiency in 'top down' control or appraisal (Klumpp et al, 2012(Klumpp et al, , 2013.…”

“…However, other paralimbic regions such as the insula and the parahippocampal gyrus also appeared to exhibit greater activation in SAD subjects (Amir et al, 2005;Blair et al, 2008Blair et al, , 2011Evans et al, 2008;Gentili et al, 2008;Goldin et al, 2009;Klumpp et al, 2010Klumpp et al, , 2012Klumpp, Post, Angstadt, Fitzgerald, & Phan, 2013;Phan et al, 2006;Yoon et al, 2007). Increased activation of limbic/paralimbic regions was the most replicated finding, and has been observed independently of task design (implicit (Blair et al, 2008(Blair et al, , 2011Gentili et al, 2008;Stein et al, 2002), explicit (Amir et al, 2005;Cooney et al, 2006;Klumpp et al, 2010Klumpp et al, , 2012Phan et al, 2006;Yoon et al, 2007), or combined (Klumpp et al, 2013;Straube et al, 2004) paradigms) at different levels of emotion intensity (Klumpp et al, 2010;Yoon et al, 2007), and even when simple-drawing schematic faces are presented (Evans et al, 2008). Using an event-related design, Klumpp et al (2010) found that SAD patients showed increased amygdala activation at both high and moderate threat intensities in comparison to matched controls.…”

“…Moreover, some data suggest that exaggerated insula reactivity may relate to a deficiency in 'top down' control or appraisal (Klumpp et al, 2012(Klumpp et al, , 2013. In this line, Klumpp et al (2013) evaluated attention control in SAD subjects and HC while performing a matching task, in which a trio of faces alongside a trio of geometrical shapes was presented simultaneously within the same field of vision. Participants were instructed to match faces or match shapes, directing attention towards or away from emotional information.…”

Altered Activation of the Rostral Anterior Cingulate Cortex in the Context of Emotional Face Distractors in Children and Adolescents With Anxiety Disorders

“…15 Moreover, adult patients with SP evidence greater insula activation during face matching and reduced rACC activation during shape matching relative to controls. 20 …”

Hjärnan formas av psykologisk behandling

“…Heightened neural reactivity in SAD is also reported in the insula (Klumpp, Post, Angstadt, Fitzgerald, & Phan, 2013b), and the ACC (Amir et al, 2005;Klumpp, Angstadt, & Phan, 2012). There are also a few studies demonstrating that the connectivity between brain regions differentiates SAD individuals from healthy controls, e.g., more positive connectivity between the dACC and the amygdala (Robinson et al, 2014); the amygdala and the fusiform gyrus (Frick, Howner, Fischer, Kristiansson, & Furmark, 2013b); and the left hippocampus-temporal pole (Pantazatos, Talati, Schneier, & Hirsch, 2014).…”