Neuroscience perspective| Volume 60, ISSUE 4, P383-387, August 15, 2006

An Insular View of Anxiety

  • Martin P. Paulus
    Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, California.

    Psychiatry Services, Veterans Affairs San Diego Health Care System, La Jolla, California.
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  • Murray B. Stein
    Address reprint requests to Murray B. Stein, M.D., M.P.H., Department of Psychiatry, UCSD, 8950 Villa La Jolla Drive, Suite B-218, La Jolla CA 92037.
    Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, California.

    Department of Family and Preventive Medicine, University of California, San Diego (UCSD), La Jolla, California.

    Psychiatry Services, Veterans Affairs San Diego Health Care System, La Jolla, California.
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      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.
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