Brain responses during the anticipation of dyspnea
Open accessAbstract
Dyspnea is common in many cardiorespiratory diseases. Already the anticipation of this aversive symptom elicits fear in many patients resulting in unfavorable health behaviors such as activity avoidance and sedentary lifestyle. This study investigated brain mechanisms underlying these anticipatory processes. We induced dyspnea using resistive-load breathing in healthy subjects during functional magnetic resonance imaging. Blocks of severe and mild dyspnea alternated, each preceded by anticipation periods. Severe dyspnea activated a network of sensorimotor, cerebellar, and limbic areas. The left insular, parietal opercular, and cerebellar cortices showed increased activation already during dyspnea anticipation. Left insular and parietal opercular cortex showed increased connectivity with right insular and anterior cingulate cortex when severe dyspnea was anticipated, while the cerebellum showed increased connectivity with the amygdala. Notably, insular activation during dyspnea perception was positively correlated with midbrain activation during anticipation. Moreover, anticipatory fear was positively correlated with anticipatory activation in right insular and anterior cingulate cortex. The results demonstrate that dyspnea anticipation activates brain areas involved in dyspnea perception. The involvement of emotion-related areas such as insula, anterior cingulate cortex, and amygdala during dyspnea anticipation most likely reflects anticipatory fear and might underlie the development of unfavorable health behaviors in patients suffering from dyspnea.
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Respiratory symptoms can be triggered by conditional learning, and individuals with elevated anxiety levels may have a particular tendency for this type of associative learning.
“Other experimental studies have shown that respiratory symptoms can be triggered due to conditional learning, and that individuals with elevated anxiety levels may have a particular tendency for this type of associative learning (Stoeckel et al., 2015, Stoeckel et al., 2016).”
From Targeting excessive avoidance behavior to reduce anxiety related to asthma: A feasibility study of an exposure-based treatment delivered online (2021) · cites this paper as Stoeckel et al., 2016
The Introduction (page unavailable) reports stronger physiological fear responses during anticipation of dyspnea, especially in anxious individuals. The Methods and Results (page unavailable) describe learned cue–dyspnea associations and greater anticipatory fear, but dyspnea itself was induced by a breathing load. The paper does not establish that conditioning alone triggers respiratory symptoms or that anxious individuals learn the association more readily. (LLM, conf=0.86)
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Self-citationAmygdala response to anticipation of dyspnea is modulated by 5‐HTTLPR genotype
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Breathlessness and the brain: the role of expectation
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“Other experimental studies have shown that respiratory symptoms can be triggered due to conditional learning, and that individuals with elevated anxiety levels may have a particular tendency for this type of associative learning (Stoeckel et al., 2015, 2016).”
Background
- Authors
- Stoeckel, M. C., Esser, R. W., Gamer, M., Büchel, C., & von Leupoldt, A.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- University of Würzburg (DE)
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Venue
- Neural Plasticity
- Publisher
- Wiley
- Published
- 2016
- Volume
- 2016
- Pages
- 1-10
- ISSN
- 1687-5443 (ISSN-L)
- 2090-5904
- PMC
- PMC5018326
- OpenAlex
- W2513590942
- Cited by
- 60
- References
- 59
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 10 · 2020: 3 · 2019: 9 · 2018: 4 · 2017: 5
- FWCI
- 5.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Neural Plasticity (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (LE 1843/9-2, LE 1843/10-1, LE 1843/10-3)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- dyspnea, anticipatory fear, insula, anterior cingulate cortex, amygdala, cerebellum, parietal operculum, midbrain, functional connectivity, cardiopulmonary disease, health behavior
- MeSH terms
- Adult, Brain, Brain Mapping, Dyspnea, Fear, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neural Pathways, Pain, Young Adult
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