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Prefrontal dysfunction during emotion regulation in generalized anxiety and panic disorders

Published online by Cambridge University Press:  31 October 2012

T. Manber Ball ,
H. J. Ramsawh ,
L. Campbell-Sills ,
M. P. Paulus  and
M. B. Stein
T. Manber Ball*
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
H. J. Ramsawh
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
L. Campbell-Sills
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
M. P. Paulus
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
M. B. Stein
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
*
*Address for correspondence: T. Manber Ball, MA, 8939 Villa La Jolla Drive, Suite 200, La Jolla, CA 92037, USA. (Email: tmball@ucsd.edu)
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Abstract

Background

The mechanisms that contribute to emotion dysregulation in anxiety disorders are not well understood. Two common disorders, generalized anxiety disorder (GAD) and panic disorder (PD), were examined to test the hypothesis that both disorders are characterized by hypo-activation in prefrontal cortex (PFC) during emotion regulation. A competing hypothesis that GAD in particular is characterized by PFC hyper-activation during emotion regulation (reflecting overactive top-down control) was also evaluated.

Method

Twenty-two medication-free healthy control (HC), 23 GAD, and 18 PD participants underwent functional magnetic resonance imaging (fMRI) during a task that required them to reappraise (i.e. reduce) or maintain emotional responses to negative images.

Results

GAD participants reported the least reappraisal use in daily life, and reappraisal use was inversely associated with anxiety severity and functional impairment in these participants. During fMRI, HCs demonstrated greater activation during both reappraisal and maintenance than either GAD or PD participants (who did not differ) in brain areas important for emotion regulation (e.g. dorsolateral and dorsomedial PFC). Furthermore, across all anxious participants, activation during reappraisal in dorsolateral and dorsomedial PFC was inversely associated with anxiety severity and functional impairment.

Conclusions

Emotion dysregulation in GAD and PD may be the consequence of PFC hypo-activation during emotion regulation, consistent with insufficient top-down control. The relationship between PFC hypo-activation and functional impairment suggests that the failure to engage PFC during emotion regulation may be part of the critical transition from dispositionally high anxiety to an anxiety disorder.

Keywords

Anxietyemotion regulationfMRIgeneralized anxiety disorderpanic disorderprefrontal cortex
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 7 , July 2013 , pp. 1475 - 1486
Copyright
Copyright © Cambridge University Press 2012 

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