Prefrontal dysfunction during emotion regulation in generalized anxiety and panic disorders
Open accessAbstract
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.
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Patients (PD/GAD) showed greater use of suppression than controls (p <0.05).
“Greater use of suppression in patients (p <0.05)”
From Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping (2023) · cites this paper as Ball et al (2013)
GAD reported less use of reappraisal than PD (p <0.005).
“GAD reported less use of reappraisal than PD (p <0.005)”
From Managing emotions in panic disorder: A systematic review of studies related to emotional intelligence, alexithymia, emotion regulation, and coping (2023) · cites this paper as Ball et al (2013)
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- Authors
- Ball, T. M., Ramsawh, H. J., Campbell-Sills, L., Paulus, M. P., & Stein, M. B.
- Affiliations
- San Diego State University (US)
- University of California San Diego (US)
- Corresponding author
- Ball, T. Manber
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2012-10-31
- Volume
- 43
- Issue
- 7
- Pages
- 1475-1486
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4308620
- OpenAlex
- W1964985504
- Cited by
- 212
- References
- 57
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 13 · 2023: 14 · 2022: 15 · 2021: 17 · 2020: 19 · 2019: 19 · 2018: 16 · 2017: 17 · 2016: 17 · 2015: 30 · 2014: 10 · 2013: 5
- FWCI
- 19.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH-64122, MH 65413, K24MH064122, R01MH065413)
- National Institute on Drug Abuse (P20DA027843)
- National Center for Research Resources (M01RR000827)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- prefrontal cortex, emotion regulation, generalized anxiety disorder, panic disorder, emotional dysregulation, cognitive reappraisal, dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, top-down control, anxiety levels, functional disability
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Brain, Brain Mapping, Emotions, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Case-Control Studies, Panic Disorder, Prefrontal Cortex, Young Adult, Functional Neuroimaging
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