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Bystritsky A, Spivak NM, Dang BH, Becerra SA, Distler MG, Jordan SE, Kuhn TP. Brain circuitry underlying the ABC model of anxiety. J Psychiatr Res 2021; 138:3-14. [PMID: 33798786 DOI: 10.1016/j.jpsychires.2021.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Anxiety Disorders are prevalent and often chronic, recurrent conditions that reduce quality of life. The first-line treatments, such as serotonin reuptake inhibitors and cognitive behavioral therapy, leave a significant proportion of patients symptomatic. As psychiatry moves toward targeted circuit-based treatments, there is a need for a theory that unites the phenomenology of anxiety with its underlying neural circuits. The Alarm, Belief, Coping (ABC) theory of anxiety describes how the neural circuits associated with anxiety interact with each other and domains of the anxiety symptoms, both temporally and spatially. The latest advancements in neuroimaging techniques offer the ability to assess these circuits in vivo. Using Neurosynth, a large open-access meta-analytic imaging database, the association between terms related to specific neural circuits was explored within the ABC theory framework. Alarm-related terms were associated with the amygdala, anterior cingulum, insula, and bed nucleus of stria terminalis. Belief-related terms were associated with medial prefrontal cortex, precuneus, bilateral temporal poles, and hippocampus. Coping-related terms were associated with the ventrolateral and dorsolateral prefrontal cortices, basal ganglia, and anterior cingulate. Neural connections underlying the functional neuroanatomy of the ABC model were observed. Additionally, there was considerable interaction and overlap between circuits associated with the symptom domains. Further neuroimaging research is needed to explore the dynamic interaction between the functional domains of the ABC theory. This will pave the way for probing the neuroanatomical underpinnings of anxiety disorders and provide an evidence-based foundation for the development of targeted treatments, such as neuromodulation.
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Affiliation(s)
- Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; BrainSonix Corporation, Sherman Oaks, CA, USA.
| | - Norman M Spivak
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; Department of Neurosurgery, UCLA, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Bianca H Dang
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Sergio A Becerra
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Margaret G Distler
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Sheldon E Jordan
- Neurology Management Associates - Los Angeles, Santa Monica, CA, USA
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA; David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Yang X, Liu J, Meng Y, Xia M, Cui Z, Wu X, Hu X, Zhang W, Gong G, Gong Q, Sweeney JA, He Y. Network analysis reveals disrupted functional brain circuitry in drug-naive social anxiety disorder. Neuroimage 2017; 190:213-223. [PMID: 29223742 DOI: 10.1016/j.neuroimage.2017.12.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 02/05/2023] Open
Abstract
Social anxiety disorder (SAD) is a common and disabling condition characterized by excessive fear and avoidance of public scrutiny. Psychoradiology studies have suggested that the emotional and behavior deficits in SAD are associated with abnormalities in regional brain function and functional connectivity. However, little is known about whether intrinsic functional brain networks in patients with SAD are topologically disrupted. Here, we collected resting-state fMRI data from 33 drug-naive patients with SAD and 32 healthy controls (HC), constructed functional networks with 34 predefined regions based on previous meta-analytic research with task-based fMRI in SAD, and performed network-based statistic and graph-theory analyses. The network-based statistic analysis revealed a single connected abnormal circuitry including the frontolimbic circuit (termed the "fear circuit", including the dorsolateral prefrontal cortex, ventral medial prefrontal cortex and insula) and posterior cingulate/occipital areas supporting perceptual processing. In this single altered network, patients with SAD had higher functional connectivity than HC. At the global level, graph-theory analysis revealed that the patients exhibited a lower normalized characteristic path length than HC, which suggests a disorder-related shift of network topology toward randomized configurations. SAD-related deficits in nodal degree, efficiency and participation coefficient were detected in the parahippocampal gyrus, posterior cingulate cortex, dorsolateral prefrontal cortex, insula and the calcarine sulcus. Aspects of abnormal connectivity were associated with anxiety symptoms. These findings highlight the aberrant topological organization of functional brain network organization in SAD, which provides insights into the neural mechanisms underlying excessive fear and avoidance of social interactions in patients with debilitating social anxiety.
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Affiliation(s)
- Xun Yang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China; Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Jin Liu
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Yajing Meng
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Mingrui Xia
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Zaixu Cui
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Xi Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xinyu Hu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wei Zhang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Gaolang Gong
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China; Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China; Department of Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China.
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, 45219, USA
| | - Yong He
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, 100875, China; IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China.
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Yun JY, Kim JC, Ku J, Shin JE, Kim JJ, Choi SH. The left middle temporal gyrus in the middle of an impaired social-affective communication network in social anxiety disorder. J Affect Disord 2017; 214:53-59. [PMID: 28266321 DOI: 10.1016/j.jad.2017.01.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies on patients diagnosed with social anxiety disorder (SAD) reported changed patterns of the resting-state functional connectivity network (rs-FCN) between the prefrontal cortices and other prefrontal, amygdalar or striatal regions. Using a graph theory approach, this study explored the modularity-based community profile and patterns of inter-/intra-modular communication for the rs-FCN in SAD. METHODS In total, for 28 SAD patients and 27 healthy controls (HC), functional magnetic resonance imaging (fMRI) data were acquired in resting-state and subjected to a graph theory analysis. RESULTS The within-module degree z-score for a hub region [out of a total of 10 hub regions ranked using the participation coefficient] named left middle temporal gyrus was impaired in SAD compared to HC, proportional to the severity of clinician-scored and patient-reported functional impairment in SAD. LIMITATIONS Most of participants included in this study were undergraduate students in their early-to-mid 20's. CONCLUSIONS This study showed the importance of functional communication from the left middle temporal gyrus with other opercular-insular-subcortical regions for better objective functioning and lesser subjective disability in SAD.
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Affiliation(s)
- Je-Yeon Yun
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Chang Kim
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, Keimyung University, Daegu, Republic of Korea
| | - Jung-Eun Shin
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine and Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
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Geiger MJ, Domschke K, Ipser J, Hattingh C, Baldwin DS, Lochner C, Stein DJ. Altered executive control network resting-state connectivity in social anxiety disorder. World J Biol Psychiatry 2016; 17:47-57. [PMID: 26452782 DOI: 10.3109/15622975.2015.1083613] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Research into the neural basis of social anxiety disorder (SAD) suggests alterations in prefrontal networks, which may in turn disrupt regulation of the limbic system. Better understanding of the disturbed interface between these networks may improve current pathogenic models of this disorder. METHODS Applying group independent component analysis (ICA) to recordings of fMRI resting-state, connectivity in the executive control network was studied in 18 patients with SAD and 15 age- and sex-matched healthy controls. RESULTS Results revealed a dissociation within the left executive control network, with SAD patients showing decreased connectivity of the orbitofrontal gyrus and increased connectivity of the middle frontal gyrus compared to healthy controls. In a subsequent seed-based functional connectivity analysis, patients with SAD displayed increased connectivity between the left orbitofrontal gyrus and the left amygdala. CONCLUSIONS Findings suggest that hypo-connectivity in the executive control network and hyper-connectivity between the orbitofrontal cortex and the amygdala may reflect a disturbance in the balance between top-down and bottom-up control processes, potentially contributing to the development of SAD.
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Affiliation(s)
| | - Katharina Domschke
- a Department of Psychiatry , University of Wuerzburg , Wuerzburg , Germany
| | - Jonathan Ipser
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Coenie Hattingh
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - David S Baldwin
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.,c Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton , Southampton , UK
| | - Christine Lochner
- d MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry , University of Stellenbosch , Stellenbosch , South Africa
| | - Dan J Stein
- b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.,e Groote Schuur Hospital, MRC Unit on Anxiety and Stress Disorders, University of Cape Town , Cape Town , South Africa
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Wong QJJ, Rapee RM. The aetiology and maintenance of social anxiety disorder: A synthesis of complimentary theoretical models and formulation of a new integrated model. J Affect Disord 2016; 203:84-100. [PMID: 27280967 DOI: 10.1016/j.jad.2016.05.069] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/24/2016] [Accepted: 05/28/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Within maintenance models of social anxiety disorder (SAD), a number of cognitive and behavioural factors that drive the persistence of SAD have been proposed. However, these maintenance models do not address how SAD develops, or the origins of the proposed maintaining factors. There are also models of the development of SAD that have been proposed independently from maintenance models. These models highlight multiple factors that contribute risk to the onset of SAD, but do not address how these aetiological factors may lead to the development of the maintaining factors associated with SAD. METHODS A systematic review of the literature was conducted to identify aetiological and maintenance models of SAD. We then united key factors identified in these models and formulated an integrated aetiological and maintenance (IAM) model of SAD. A systematic review of the literature was then conducted on the components of the IAM model. RESULTS A number of aetiological and maintaining factors were identified in models of SAD. These factors could be drawn together into the IAM model. On balance, there is empirical evidence for the association of each of the factors in the IAM model with social anxiety or SAD, providing preliminary support for the model. LIMITATIONS There are relationships between components of the IAM model that require empirical attention. Future research will need to continue to test the IAM model. CONCLUSIONS The IAM model provides a framework for future investigations into the development and persistence of SAD.
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Affiliation(s)
- Quincy J J Wong
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Enter D, Terburg D, Harrewijn A, Spinhoven P, Roelofs K. Single dose testosterone administration alleviates gaze avoidance in women with Social Anxiety Disorder. Psychoneuroendocrinology 2016; 63:26-33. [PMID: 26402923 DOI: 10.1016/j.psyneuen.2015.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/28/2015] [Accepted: 09/08/2015] [Indexed: 12/18/2022]
Abstract
Gaze avoidance is one of the most characteristic and persistent social features in people with Social Anxiety Disorder (SAD). It signals social submissiveness and hampers adequate social interactions. Patients with SAD typically show reduced testosterone levels, a hormone that facilitates socially dominant gaze behavior. Therefore we tested as a proof of principle whether single dose testosterone administration can reduce gaze avoidance in SAD. In a double-blind, within-subject design, 18 medication-free female participants with SAD and 19 female healthy control participants received a single dose of 0.5mg testosterone and a matched placebo, at two separate days. On each day, their spontaneous gaze behavior was recorded using eye-tracking, while they looked at angry, happy, and neutral facial expressions. Testosterone enhanced the percentage of first fixations to the eye-region in participants with SAD compared to healthy controls. In addition, SAD patients' initial gaze avoidance in the placebo condition was associated with more severe social anxiety symptoms and this relation was no longer present after testosterone administration. These findings indicate that single dose testosterone administration can alleviate gaze avoidance in SAD. They support theories on the dominance enhancing effects of testosterone and extend those by showing that effects are particularly strong in individuals featured by socially submissive behavior. The finding that this core characteristic of SAD can be directly influenced by single dose testosterone administration calls for future inquiry into the clinical utility of testosterone in the treatment of SAD.
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Affiliation(s)
- Dorien Enter
- Radboud University Nijmegen, Behavioural Science Institute (BSI), 6500 HE, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525 EN, Nijmegen, The Netherlands; Leiden University, Institute of Psychology, 2300 RB, Leiden, The Netherlands.
| | - David Terburg
- Utrecht University, Department of Psychology, 3584 CS, Utrecht, The Netherlands; University of Cape Town, Department of Psychiatry & Mental Health, Cape Town 7925, South Africa
| | - Anita Harrewijn
- Leiden University, Institute of Psychology, 2300 RB, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, 2300 RC, Leiden, The Netherlands
| | - Philip Spinhoven
- Leiden University, Institute of Psychology, 2300 RB, Leiden, The Netherlands; Leiden University Medical Center, Department of Psychiatry, 2300 RC, Leiden, The Netherlands
| | - Karin Roelofs
- Radboud University Nijmegen, Behavioural Science Institute (BSI), 6500 HE, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, 6525 EN, Nijmegen, The Netherlands
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7
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Volman I, von Borries AKL, Bulten BH, Verkes RJ, Toni I, Roelofs K. Testosterone Modulates Altered Prefrontal Control of Emotional Actions in Psychopathic Offenders(1,2,3). eNeuro 2016; 3:ENEURO.0107-15.2016. [PMID: 26878057 PMCID: PMC4745181 DOI: 10.1523/eneuro.0107-15.2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/15/2015] [Accepted: 01/03/2016] [Indexed: 11/21/2022] Open
Abstract
Psychopathic individuals are notorious for their controlled goal-directed aggressive behavior. Yet, during social challenges, they often show uncontrolled emotional behavior. Healthy individuals can control their social emotional behavior through anterior prefrontal cortex (aPFC) downregulation of neural activity in the amygdala, with testosterone modulating aPFC-amygdala coupling. This study tests whether individual differences in this neuroendocrine system relate to the paradoxical lack of emotional control observed in human psychopathic offenders. Emotional control was operationalized with an fMRI-adapted approach-avoidance task requiring rule-driven control over rapid emotional responses. Fifteen psychopathic offenders and 19 matched healthy control subjects made approaching and avoiding movements in response to emotional faces. Control of social emotional behavior was required during affect-incongruent trials, when participants had to override affect-congruent, automatic action tendencies and select the opposite response. Psychopathic offenders showed less control-related aPFC activity and aPFC-amygdala coupling during trials requiring control of emotional actions, when compared with healthy control subjects. This pattern was particularly pronounced in psychopathic individuals with high endogenous testosterone levels. These findings suggest that reduced prefrontal coordination underlies reduced behavioral control in psychopathic offenders during emotionally provoking situations. Even though the modest sample size warrants replication, the modulatory role of endogenous testosterone on the aPFC-amygdala circuit suggests a neurobiological substrate of individual differences that is relevant for the advancement of treatment and the reduction of recidivism.
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Affiliation(s)
- Inge Volman
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Behavioural Science Institute, Radboud University Nijmegen, 6525 HR, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
| | - Anna Katinka Louise von Borries
- Behavioural Science Institute, Radboud University Nijmegen, 6525 HR, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
- Department of Psychiatry, UMC Sint Radboud, 6525 GA, Nijmegen, The Netherlands
- Pompestichting, 6532 CN, Nijmegen, The Netherlands
| | | | - Robbert Jan Verkes
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
- Department of Psychiatry, UMC Sint Radboud, 6525 GA, Nijmegen, The Netherlands
- Pompestichting, 6532 CN, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
| | - Karin Roelofs
- Behavioural Science Institute, Radboud University Nijmegen, 6525 HR, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, 6525 EN, Nijmegen, The Netherlands
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Nagata T, Suzuki F, Teo AR. Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review. Psychiatry Clin Neurosci 2015; 69:724-40. [PMID: 26121185 DOI: 10.1111/pcn.12327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.
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Affiliation(s)
| | - Futoshi Suzuki
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Aichi, Japan
| | - Alan R Teo
- VA Portland Health Care System and Oregon Health & Science University, Oregon, USA
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Taylor JM, Whalen PJ. Neuroimaging and Anxiety: the Neural Substrates of Pathological and Non-pathological Anxiety. Curr Psychiatry Rep 2015; 17:49. [PMID: 25957101 DOI: 10.1007/s11920-015-0586-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Advances in the use of noninvasive neuroimaging to study the neural correlates of pathological and non-pathological anxiety have shone new light on the underlying neural bases for both the development and manifestation of anxiety. This review summarizes the most commonly observed neural substrates of the phenotype of anxiety. We focus on the neuroimaging paradigms that have shown promise in exposing this relevant brain circuitry. In this way, we offer a broad overview of how anxiety is studied in the neuroimaging laboratory and the key findings that offer promise for future research and a clearer understanding of anxiety.
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Affiliation(s)
- James M Taylor
- Department of Psychological and Brain Sciences, Dartmouth College, 6207 Moore Hall, Hanover, NH, 03755, USA,
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Cremers HR, Veer IM, Spinhoven P, Rombouts SARB, Roelofs K. Neural sensitivity to social reward and punishment anticipation in social anxiety disorder. Front Behav Neurosci 2015; 8:439. [PMID: 25601830 PMCID: PMC4283602 DOI: 10.3389/fnbeh.2014.00439] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/02/2014] [Indexed: 11/13/2022] Open
Abstract
An imbalance in the neural motivational system may underlie Social Anxiety Disorder (SAD). This study examines social reward and punishment anticipation in SAD, predicting a valence-specific effect: increased striatal activity for punishment avoidance compared to obtaining a reward. Individuals with SAD (n = 20) and age, gender, and education case-matched controls (n = 20) participated in a functional magnetic resonance imaging (fMRI) study. During fMRI scanning, participants performed a Social Incentive Delay (SID) task to measure the anticipation of social reward and punishment. The left putamen (part of the striatum) showed a valence-specific interaction with group after correcting for medication use and comorbidity. The control group showed a relatively stronger activation for reward vs. punishment trials, compared to the social anxiety group. However, post-hoc pairwise comparisons were not significant, indicating that the effect is driven by a relative difference. A connectivity analysis (Psychophysiological interaction) further revealed a general salience effect: SAD patients showed decreased putamen-ACC connectivity compared to controls for both reward and punishment trials. Together these results suggest that the usual motivational preference for social reward is absent in SAD. In addition, cortical control processes during social incentive anticipation may be disrupted in SAD. These results provide initial evidence for altered striatal involvement in both valence-specific and valence-nonspecific processing of social incentives, and stress the relevance of taking motivational processes into account when studying social anxiety.
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Affiliation(s)
- Henk R Cremers
- Radboud University Nijmegen, Behavioral Science Institute Nijmegen, Netherlands ; Biological Science Department, Department of Psychiatry, University of Chicago Chicago, IL, USA ; Leiden Institute for Brain and Cognition Leiden, Netherlands
| | - Ilya M Veer
- Leiden Institute for Brain and Cognition Leiden, Netherlands ; Department of Radiology, Leiden University Medical Center Leiden, Netherlands ; Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
| | - Philip Spinhoven
- Leiden Institute for Brain and Cognition Leiden, Netherlands ; Institute of Psychology, Leiden University Leiden, Netherlands ; Department of Psychiatry, Leiden University Medical Center Leiden, Netherlands
| | - Serge A R B Rombouts
- Leiden Institute for Brain and Cognition Leiden, Netherlands ; Department of Radiology, Leiden University Medical Center Leiden, Netherlands ; Institute of Psychology, Leiden University Leiden, Netherlands
| | - Karin Roelofs
- Radboud University Nijmegen, Behavioral Science Institute Nijmegen, Netherlands ; Donders Institute for Brain, Cognition and Behavior Nijmegen, Netherlands
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11
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R K, D M A, C N, S N W, C D. Oxidative imbalance and anxiety disorders. Curr Neuropharmacol 2014; 12:193-204. [PMID: 24669212 PMCID: PMC3964749 DOI: 10.2174/1570159x11666131120223530] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 05/15/2013] [Accepted: 11/02/2013] [Indexed: 01/22/2023] Open
Abstract
The oxidative imbalance appears to have an important role in anxiety development. Studies in both humans and animals have shown a strong correlation between anxiety and oxidative stress. In humans, for example, the increased malondialdehyde levels and discrepancies in antioxidant enzymes in erythrocytes have been observed. In animals, several studies also show that anxiety-like behavior is related to the oxidative imbalance. Moreover, anxiety-like behavior can be caused by pharmacological-induced oxidative stress. Studies using knockout or overexpression of antioxidant enzymes have shown a relationship between anxiety-like behavior and oxidative stress. Related factors of oxidative stress that could influence anxious behavior are revised, including impaired function of different mitochondrial proteins, inflammatory cytokines, and neurotrophic factors. It has been suggested that a therapy specifically focus in reducing reactive species production may have a beneficial effect in reducing anxiety. However, the neurobiological pathways underlying the effect of oxidative stress on anxiety symptoms are not fully comprehended. The challenge now is to identify the oxidative stress mechanisms likely to be involved in the induction of anxiety symptoms. Understanding these pathways could help to clarify the neurobiology of the anxiety disorder and provide tools for new discovery in therapies and preventive strategies.
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Affiliation(s)
- Krolow R
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Arcego D M
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Noschang C
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Weis S N
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Dalmaz C
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
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Pannekoek JN, van der Werff SJ, Stein DJ, van der Wee NJ. Advances in the neuroimaging of panic disorder. Hum Psychopharmacol 2013; 28:608-11. [PMID: 24038132 DOI: 10.1002/hup.2349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/01/2013] [Indexed: 12/25/2022]
Abstract
Models of the neuroanatomy of panic disorder (PD) have relied on both animal work on fear and on clinical data from neuroimaging. Early work hypothesised a network of brain regions involved in fear processing (e.g. the amygdala), but more recent work has also pointed to the involvement of other cortical areas and other brain circuitry (e.g. the insula and anterior cingulate cortex). Studies investigating functional and structural brain connectivity in PD may ultimately shed light on the extent to which the neuroanatomy of PD is localised versus distributed, and on how current treatments alter this neuroanatomy.
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Affiliation(s)
- Justine Nienke Pannekoek
- Department of Psychiatry; Leiden University Medical Centre; Leiden The Netherlands
- Leiden Institute for Brain and Cognition; Leiden University; The Netherlands
- Department of Psychiatry and Mental Health; University of Cape Town; Cape Town South Africa
| | - Steven J.A. van der Werff
- Department of Psychiatry; Leiden University Medical Centre; Leiden The Netherlands
- Leiden Institute for Brain and Cognition; Leiden University; The Netherlands
| | - Dan J. Stein
- Department of Psychiatry and Mental Health; University of Cape Town; Cape Town South Africa
| | - Nic J.A. van der Wee
- Department of Psychiatry; Leiden University Medical Centre; Leiden The Netherlands
- Leiden Institute for Brain and Cognition; Leiden University; The Netherlands
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Multivariate classification of social anxiety disorder using whole brain functional connectivity. Brain Struct Funct 2013; 220:101-15. [PMID: 24072164 DOI: 10.1007/s00429-013-0641-4] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/12/2013] [Indexed: 01/21/2023]
Abstract
Recent research has shown that social anxiety disorder (SAD) is accompanied by abnormalities in brain functional connections. However, these findings are based on group comparisons, and, therefore, little is known about whether functional connections could be used in the diagnosis of an individual patient with SAD. Here, we explored the potential of the functional connectivity to be used for SAD diagnosis. Twenty patients with SAD and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. The whole brain was divided into 116 regions based on automated anatomical labeling atlas. The functional connectivity between each pair of regions was computed using Pearson's correlation coefficient and used as classification feature. Multivariate pattern analysis was then used to classify patients from healthy controls. The pattern classifier was designed using linear support vector machine. Experimental results showed a correct classification rate of 82.5 % (p < 0.001) with sensitivity of 85.0 % and specificity of 80.0 %, using a leave-one-out cross-validation method. It was found that the consensus connections used to distinguish SAD were largely located within or across the default mode network, visual network, sensory-motor network, affective network, and cerebellar regions. Specifically, the right orbitofrontal region exhibited the highest weight in classification. The current study demonstrated that functional connectivity had good diagnostic potential for SAD, thus providing evidence for the possible use of whole brain functional connectivity as a complementary tool in clinical diagnosis. In addition, this study confirmed previous work and described novel pathophysiological mechanisms of SAD.
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