Mount Sinai School of Medicine | Department of Neurology

Anxiety

While insula activation, especially left, is consistent with prior neural studies of anxiety, the robust left insula activation observed here, specifically associated with Impending Threat, offers potential insight into the neural processes invoked during normal anticipatory anxiety and its pathologic correlates.

Habituation

Habituation Context-appropriate habituation to impending threat, afforded by experience, represents an important function characterizing healthy mental adaptation. Pathologic failure of habituation is a component of a variety of neuropsychiatric disease states marked by inappropriately persistent anticipatory anxiety (e.g., phobias).

Anxiety

Anxiety is an evolutionarily old, multi-system response repertoire, offering adaptive advantage for avoidance of homeostasis-threatening stimuli. Although customarily regarded as a singular subjective experience, anxiety is a multifaceted, complexly layered, psycho-physiologic phenomenon, comprising cognitive, affective, and autonomic components.

Anticipatory anxiety involves multiple cognitive, affective, and physiologic sub-functions. Although multiple brain imaging studies have robustly demonstrated neural responses to “Threat”, explicit neural distinction of anticipatory anxiety from fear (via neuropsychological segregation impending from immediate threat of aversive stimulation) has been less thoroughly investigated and therefore leaves a critical gap in the understanding of neural mechanisms in anxiety disorders. This is especially relevant to disease states marked by hyper-sensitivity to anticipated harm (e.g., phobias), in which pathologically exaggerated anticipatory processing may represent a key vulnerability.

PPD Figure 1

Galvanic Skin Response (GSR) data (sample section presented) suggests successful induction of anticipatory anxiety. GSR (red) amplitude demonstrates increased levels of arousal to “Threat” stimulus conditions. “Target”, “Safe” and “Threat” markers indicate the temporal position of visual stimulus.