We propose a general hypothesis that integrates affective and cognitive processing
with neuroanatomy to explain anxiety pronenes. The premise is that individuals who
are prone to anxiety show an altered interoceptive prediction signal, i.e., manifest
augmented detection of the difference between the observed and expected body state.
As a consequence, the increased prediction signal of a prospective aversive body state
triggers an increase in anxious affect, worrisome thoughts and other avoidance behaviors.
The anterior insula is proposed to play a key role in this process. Further testing
of this model—which should include investigation of genetic and environmental influences—may
lead to the development of novel treatments that attenuate this altered interoceptive
prediction signal in patients with anxiety disorders.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Biological PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Perceived functions of worry among generalized anxiety disorder subjects.J Behav Ther Exp Psychiatry. 1995; 26: 25-30
- Conflict monitoring and anterior cingulate cortex.Trends Cogn Sci. 2004; 8: 539-546
- A modern learning theory perspective on the etiology of panic disorder.Psychol Rev. 2001; 108: 4-32
- The contribution of the anterior cingulate cortex to executive processes in cognition.Rev Neurosci. 1999; 10: 49-57
- Neuroanatomical circuits modulating fear and anxiety behaviors.Acta Psychiatr Scand Suppl. 2003; : 38-50
- Enhancement of antibody production and expression of c-Fos in the insular cortex in response to a conditioned stimulus after a single-trial learning paradigm.Behav Brain Res. 2004; 154: 557-565
- A cognitive approach to panic.Behav Res Ther. 1986; 24: 461-470
- How do you feel? Interoception: the sense of the physiological condition of the body.Nat Rev Neurosci. 2002; 3: 655-666
- Neural systems supporting interoceptive awareness.Nat Neurosci. 2004; 7: 189-195
- Neuroimaging abnormalities in the amygdala in mood disorders.Ann N Y Acad Sci. 2003; 985: 420-444
- Effects of citalopram on worry and brain activation in patients with generalized anxiety disorder.Psychiatry Res. 2004; 131: 11-21
- The role of the central nucleus of the amygdala in mediating fear and anxiety in the primate.J Neurosci. 2004; 24: 5506-5515
- Neural correlates of speech anticipatory anxiety in generalized social phobia.Neuroreport. 2004; 15: 2701-2705
- Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder.Arch Gen Psychiatry. 1998; 55: 715-720
- Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder.Arch Gen Psychiatry. 2004; 61: 564-576
- A contemporary learning theory perspective on the etiology of anxiety disorders.Am Psychol. 2006; 61: 10-26
- Functional neuroanatomy of aversion and its anticipation.Neuroimage. 2006; 29: 106-116
- The organization of networks within the orbital and medial prefrontal cortex of rats, monkeys and humans.Cereb Cortex. 2000; 10: 206-219
- The primate amygdala represents the positive and negative value of visual stimuli during learning.Nature. 2006; 439: 865-870
- Dose-dependent decrease of activation in bilateral amygdala and insula by Lorazepam during emotion processing.Arch Gen Psychiatry. 2005; 62: 282-288
- Increased activation in the right insula during risk-taking decision making is related to harm avoidance and neuroticism.Neuromage. 2003; 19: 1439-1488
- Dissociating pain from its anticipation in the human brain.Science. 1999; 284: 1979-1981
- The functional neuroanatomy of anxiety.Biol Psychiatry. 1997; 42: 446-452
- Neuroimaging studies of amygdala function in anxiety disorders.Ann N Y Acad Sci. 2003; 985: 389-410
- Addiction as a computational process gone awry.Science. 2004; 306: 1944-1947
- Anxiety sensitivity, anxiety frequency and the prediction of fearfulness.Behav Res Ther. 1986; 24: 1-8
- Specificity in the projections of prefrontal and insular cortex to ventral striatopallidum and the extended amygdala.J Neurosci. 2005; 25: 11757-11767
- Developmental antecedents of anxiety sensitivity.J Anxiety Disorders. 2003; 17: 253-269
- A neural substrate of prediction and reward.Science. 1997; 275: 1593-1599
- The phylogeny and ontogeny of behavior. Contingencies of reinforcement throw light on contingencies of survival in the evolution of behavior.Science. 1966; 153: 1205-1213
- Heritability of anxiety sensitivity.Am J Psychiatry. 1999; 156: 246-251
Stein MB, Simmons A, Feinstein JS, Paulus MP (in press): Increased amygdala and insula activation during emotion processing in anxiety-prone subjects. Am J Psychiatry.
- Amygdala and insular responses to emotionally valenced human faces in small animal specific phobia.Biol Psychiatry. 2003; 54: 1067-1076
Article info
Publication history
Published online: June 15, 2006
Accepted:
March 31,
2006
Received in revised form:
March 29,
2006
Received:
December 22,
2005
Identification
Copyright
© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
