Department of Psychiatry and Behavioral Sciences, the Center for Interdisciplinary Brain Science Research, and the Program in Neuroscience, Stanford University, USA.
Am J Psychiatry. 2010 May;167(5):545-54. doi: 10.1176/appi.ajp.2009.09070931. Epub 2010 Feb 1.
Clinical data suggest that abnormalities in the regulation of emotional processing contribute to the pathophysiology of generalized anxiety disorder, yet these abnormalities remain poorly understood at the neurobiological level. The authors recently reported that in healthy volunteers the pregenual anterior cingulate regulates emotional conflict on a trial-by-trial basis by dampening activity in the amygdala. The authors also showed that this process is specific to the regulation of emotional, compared to nonemotional, conflict. Here the authors examined whether this form of noninstructed emotion regulation is perturbed in generalized anxiety disorder.
Seventeen patients with generalized anxiety disorder and 24 healthy comparison subjects underwent functional MRI while performing an emotional conflict task that involved categorizing facial affect while ignoring overlaid affect label words. Behavioral and neural measures were used to compare trial-by-trial changes in conflict regulation.
Comparison subjects effectively regulated emotional conflict from trial to trial, even though they were unaware of having done so. By contrast, patients with generalized anxiety disorder were completely unable to regulate emotional conflict and failed to engage the pregenual anterior cingulate in ways that would dampen amygdalar activity. Moreover, performance and brain activation were correlated with symptoms and could be used to accurately classify the two groups.
These data demonstrate that patients with generalized anxiety disorder show significant deficits in the noninstructed and spontaneous regulation of emotional processing. Conceptualization of anxiety as importantly involving abnormalities in emotion regulation, particularly a type occurring outside of awareness, may open up avenues for novel treatments, such as by targeting the medial prefrontal cortex.
临床数据表明，情绪处理调节异常与广泛性焦虑障碍的病理生理学有关，但在神经生物学水平上，这些异常仍然知之甚少。作者最近报告称，在健康志愿者中，扣带回前下区调节情绪冲突的方式是通过抑制杏仁核的活动来调节情绪冲突。作者还表明，这一过程是特定于情绪冲突的调节，而不是非情绪冲突的调节。在此，作者研究了这种非指令性情绪调节在广泛性焦虑障碍中的紊乱情况。
17 名广泛性焦虑障碍患者和 24 名健康对照者在执行一项情绪冲突任务时接受了功能性磁共振成像检查，该任务涉及在忽略叠加的情绪标签词的情况下对面部表情进行分类。作者使用行为和神经测量来比较冲突调节的逐次变化。
对照组有效地从一次试验到另一次试验调节情绪冲突，即使他们不知道自己已经这样做了。相比之下，广泛性焦虑障碍患者完全无法调节情绪冲突，并且无法以抑制杏仁核活动的方式激活扣带回前下区。此外，表现和大脑激活与症状相关，可以用于准确地对两组进行分类。
这些数据表明，广泛性焦虑障碍患者在非指令性和自发的情绪处理调节方面存在明显缺陷。将焦虑概念化为重要地涉及情绪调节异常，特别是一种在意识之外发生的异常，可能为新的治疗方法开辟途径，例如通过靶向内侧前额叶皮层。
