Brain activation during anticipatory anxiety in social anxiety disorder

Abstract

Exaggerated anticipatory anxiety during expectation of performance-related situations is an important feature of the psychopathology of social anxiety disorder (SAD). The neural basis of anticipatory anxiety in SAD has not been investigated in controlled studies. The current study used functional magnetic resonance imaging (fMRI) to investigate the neural correlates during the anticipation of public and evaluated speaking vs a control condition in 17 SAD patients and 17 healthy control subjects. FMRI results show increased activation of the insula and decreased activation of the ventral striatum in SAD patients, compared to control subjects during anticipation of a speech vs the control condition. In addition, an activation of the amygdala in SAD patients during the first half of the anticipation phase in the speech condition was observed. Finally, the amount of anticipatory anxiety of SAD patients was negatively correlated to the activation of the ventral striatum. This suggests an association between incentive function, motivation and anticipatory anxiety when SAD patients expect a performance situation.

Elevated amygdala activity during reappraisal anticipation predicts anxiety in avoidant personality disorder

“…During reappraisal anticipation, avoidant patients showed pronounced hyper-reactivity in the bilateral amygdala in a manner consistent with prior work assessing the neural correlates of anticipatory anxiety in social anxiety disorder patients (Boehme et al, in press; Lorberbaum et al, 2004). Indeed, avoidant personality disorder has much in common with social anxiety disorder, a condition characterized by a marked and intense fear of social settings in which the individual is exposed to possible scrutiny by others (American Psychiatric Association, 2013).…”

“…Variable, though often substantial, comorbidity between social anxiety disorder (also known as generalized social phobia) and avoidant personality disorder has been reported (Reich, 2009), though avoidant personality disorder is thought to be the more serious of the two disorders in terms of functional impairment and symptom severity (Marques et al, 2012; Reich, 2009; Rettew, 2000; Sanislow et al, 2012). Importantly, in addition to during stimulus presentation, amygdala activity has been associated with anticipation of aversive events in social anxiety disorder patients (Boehme et al, in press; Lorberbaum et al, 2004) as well as in healthy participants (Herwig et al, 2007; Ueda et al, 2003), though the effects in social anxiety disorder patients have been shown to be significantly greater than those shown by healthy controls (Boehme et al, in press; Lorberbaum et al, 2004). …”

Hjärnan formas av psykologisk behandling

“…Further, during the anticipation of emotional stimuli of prior known negative and ambiguous emotional valence, elevated amygdala activation was found in SAD individuals relative to controls, and such neural response correlated with social anxiety symptoms (Brühl et al, 2011). SAD individuals have also showed increased insula activity while anticipating a speech task (Boehme et al, 2014b). The amygdala also showed heightened activation in this study, but only at the beginning of the speech anticipatory phase.…”

“…Along these lines, there are neuroimaging case-control studies on SAD suggesting that aberrant neural signalling alters over shorter periods of time. Boehme et al suggest that exaggerated amygdala responsivity in SAD individuals are evident early on (first half of the BOLD-fMRI experiment) while anticipating a speech (Boehme et al, 2014b) or viewing others engaging in social interactions (Boehme et al, 2014a), but not later on during the experimantal manipulation. Time-dependent activations in SAD individuals have also been observed in other extended action tasks, particularly in the prefrontal cortex (Goldin et al, 2009b;Goldin et al, 2013).…”

Area-dependent time courses of brain activation during video-induced symptom provocation in social anxiety disorder

“…By means of functional brain imaging, heightened activation of the amygdala has been found during the processing of disorder-related stimuli (for example, [2-9]) as well as during symptom provocation in SAD patients (for example, [10-14]), supporting the assumed role of the amygdala in threat processing [15,16]. Furthermore, several other regions have been associated with increased activation in SAD, including medial prefrontal areas, for example, dorsal anterior cingulate cortex (ACC) and dorsomedial prefrontal cortex (dmPFC), and the insular cortex (for example, [3,5,8,10,17-20]). Medial prefrontal cortex areas have been proposed to be linked to explicit emotional evaluation, emotional-cognitive interactions, self-referential processing, and emotion-regulation [21-26].…”