Brain Structure and Function

, Volume 214, Issue 5, pp 535-549

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Conjoint activity of anterior insular and anterior cingulate cortex: awareness and response

  • Nick MedfordAffiliated withDepartment of Psychiatry, Brighton and Sussex Medical School Email author 
  • , Hugo D. CritchleyAffiliated withDepartment of Psychiatry, Brighton and Sussex Medical School


There is now a wealth of evidence that anterior insular and anterior cingulate cortices have a close functional relationship, such that they may be considered together as input and output regions of a functional system. This system is typically engaged across cognitive, affective, and behavioural contexts, suggesting that it is of fundamental importance for mental life. Here, we review the literature and reinforce the case that these brain regions are crucial, firstly, for the production of subjective feelings and, secondly, for co-ordinating appropriate responses to internal and external events. This model seeks to integrate higher-order cortical functions with sensory representation and autonomic control: it is argued that feeling states emerge from the raw data of sensory (including interoceptive) inputs and are integrated through representations in conscious awareness. Correspondingly, autonomic nervous system reactivity is particularly important amongst the responses that accompany conscious experiences. Potential clinical implications are also discussed.


Insula Anterior cingulate cortex Functional connectivity Autonomic nervous system Subjective awareness