Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review

Across studies, a general pattern emerges of disrupted prefrontal activity in individuals with social anxiety disorder compared to healthy controls when they are explicitly instructed to use a regulatory strategy.

“Across these studies, there is a general trend for disrupted (increased or decreased) levels of activity in prefrontal regions (dorsolateral and ventrolateral prefrontal cortex, dl/vlPFC, dorsal anterior cingulate cortex, dACC) among individuals with SAD, relative to healthy control participants when explicitly instructed to engage in a regulatory strategy (for recent meta-analyses, see Brühl et”

Atypical recruitment of cortical regions, including dl/vl/mPFC and ACC, in SAD may be associated with emotion regulation deficits.

“Moreover, aberrant recruitment of cortical regions in SAD, including dorsolateral, ventrolateral, and medial prefrontal cortex (dl/vl/mPFC) and anterior cingulate cortex (ACC), may be linked to deficits in emotion regulation (Brühl, Delsignore, et al., 2014; Picó-Pérez, Radua, Steward, Menchón, & Soriano-Mas, 2017; Zilverstand, Parvaz, & Goldstein, 2017).”

During cognitive reappraisal tasks, depressed patients have shown decreased activation in lateral and medial PFC coupled with increases in amygdalar response, and altered mPFC-amygdalar connectivity, suggesting impaired volitional PFC regulation of the amygdala.

“During 'cognitive reappraisal' tasks, in which volitional attempts are made to down-regulate subjective negative responses to negative stimuli 62 , depressed patients have shown decreased activation in lateral and medial PFC coupled with increases in amygdalar response 63,64 , and altered mPFC-amygdalar connectivity 65 , suggesting impaired volitional PFC regulation of the amygdala.”

The dorsolateral prefrontal cortex is thought critical for top-down conscious reappraisal when reprocessing emotionally latent memories, such as traumatic experiences, in order to dampen the negative affect associated with them.

“In particular, the dorsolateral prefrontal cortex is thought critical for top-down conscious reappraisal when reprocessing emotionally latent memories, such as traumatic experiences, in order to dampen the negative affect associated with them (Picó-Pérez et al., 2017; Ligeza et al., 2016; Zilverstand et al., 2017).”

The dorsal attentional network and the default-mode network work in tandem to facilitate further activation of the central executive network necessary to carry out higher-order cognitive tasks, including emotional regulatory processes, which are typically altered among individuals with PTSD.

“The dorsal attentional network and the default-mode network are thought to work in tandem to facilitate further activation of the central executive network necessary to carry out higher-order cognitive tasks, including emotional regulatory processes (Picó-Pérez et al., 2017; Zilverstand et al., 2017) typically altered among individuals with PTSD (Steinvorth et al., 2006; Andrews-Hanna et al., 2014”

Prior findings disagree about which prefrontal subregions are involved and whether activation is increased or decreased relative to healthy controls.

“However, findings have been inconsistent regarding the specific prefrontal sub-regions as well as direction of effects (both relatively increased (Brühl, Delsignore, et al., 2014; Goldin et al., 2009) or decreased activation (Zilverstand et al., 2017) compared to healthy individuals).”

Disruptions in this inhibitory control mechanism may underlie deficient emotion regulation across diagnostic categories.

“Disruptions in this inhibitory control mechanism may underlie deficient emotion regulation across diagnostic categories (McTeague et al., 2020, Zilverstand et al., 2017).”