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Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study

  • Psychiatry and Preclinical Psychiatric Studies - Original Article
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Abstract

Cognitive behavioral models of panic disorder (PD) stress the importance of an increased attentional focus towards bodily symptoms in the onset and maintenance of this debilitating anxiety disorder. In this fMRI mental tracking paradigm, we looked at the effects of focusing one’s attention internally (interoception) vs. externally (exteroception) in a well-studied group at risk for PD—that is anxiety-sensitive females (AS-high). We hypothesized that AS-high subjects compared to control subjects will present higher arousal and decreased valence scores during interoception and parallel higher activity in brain areas which are associated with fear and interoception. 24 healthy female students with high levels of anxiety sensitivity and 24 healthy female students with normal levels of anxiety sensitivity serving as control group were investigated by 3 T fMRI. Subjects either focused their attention on their heartbeats (internal condition) or on neutral tones (external condition). Task performance was monitored by reporting the number of heartbeats or tones after each block. State of arousal and emotional valence were also assessed. The high anxiety-sensitive group reported higher arousal scores compared to controls during the course of the experiment. Simultaneously, fMRI results indicated higher activation in anxiety-sensitive participants than in controls during interoception in a network of cortical and subcortical brain regions (thalamus, amygdala, parahippocampus) that overlaps with known fear circuitry structures. In particular, the activity of the right amygdala was up-regulated. Future prospective-longitudinal studies are needed to validate the role of the amygdala for transition to disorder. Attention to internal body functions up-regulates the activity of interoceptive and fear-relevant brain regions in anxiety-sensitive females, a high-risk group for the development of anxiety disorders.

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Acknowledgments

This study was partially funded by the German Federal Ministry of Education and Research (BMBF; projects no. 01GV0611 (neuroimaging study) and No. 01GV0610) as part of the BMBF Psychotherapy Research Funding Initiative.

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Authors and Affiliations

  1. Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Campus 1, Building A1, 48129, Münster, Germany

    Bettina Pfleiderer & Adrianna Ewert

  2. Department of Clinical Psychology, University of Münster, Münster, Germany

    Timo Berse & Daniel Stroux

  3. Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany

    Carsten Konrad

  4. Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany

    Carsten Konrad

  5. Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany

    Alexander L. Gerlach

Authors
  1. Bettina Pfleiderer
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  2. Timo Berse
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  3. Daniel Stroux
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  4. Adrianna Ewert
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  5. Carsten Konrad
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  6. Alexander L. Gerlach
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Correspondence to Bettina Pfleiderer.

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Pfleiderer, B., Berse, T., Stroux, D. et al. Internal focus of attention in anxiety-sensitive females up-regulates amygdale activity: an fMRI study. J Neural Transm 121, 1417–1428 (2014). https://doi.org/10.1007/s00702-014-1248-5

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  • DOI: https://doi.org/10.1007/s00702-014-1248-5

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