Díaz Dana E, Russman Block Stefanie R, Becker Hannah C, Phan K Luan, Monk Christopher S, Fitzgerald Kate D
Columbia University Irving Medical Center, New York, New York.
University of Michigan, Ann Arbor, Michigan.
J Am Acad Child Adolesc Psychiatry. 2025 Apr;64(4):488-498. doi: 10.1016/j.jaac.2024.06.010. Epub 2024 Jul 24.
Clinically anxious youth are hypervigilant to emotional stimuli and display difficulty shifting attention from emotional to nonemotional stimuli, suggesting impairments in cognitive control over emotion. However, it is unknown whether the neural substrates of such biases vary across the clinical-to-nonclinical range of anxiety or by age.
Youth aged 7 to 17 years with clinical anxiety (n = 119) or without an anxiety diagnosis (n = 41) matched emotional faces or matched shapes flanked by emotional face distractors during magnetic resonance imaging, probing emotion processing and cognitive control over emotion, respectively. Building from the National Institute of Mental Health Research Domain Criteria (RDoC) framework, clinically anxious youth were sampled across diagnostic categories, and non-clinically affected youth were sampled across minimal-to-subclinical severity.
Across both conditions, anxiety severity was associated with hyperactivation in the right inferior parietal lobe, a substrate of hypervigilance. Brain-anxiety associations were also differentiated by attentional state; anxiety severity was associated with greater left ventrolateral prefrontal cortex activation during emotion processing (face matching) and greater activation in the left posterior superior temporal sulcus and temporoparietal junction (and slower responses) during cognitive control over emotion (shape matching). Age also moderated associations between anxiety and cognitive control over emotion, such that anxiety was associated with greater right thalamus and bilateral posterior cingulate cortex activation for children at younger and mean ages, but not for older youth.
Aberrant function in brain regions implicated in stimulus-driven attention to emotional distractors may contribute to anxiety in youth. Results support the potential utility of attention modulation interventions for anxiety that are tailored to developmental stage.
Preferential attention to threat, an adaptive mechanism for detecting danger, is exaggerated in clinically anxious youth. This study included 150 youth aged 7 to 17 years spanning the clinical-nonclinical range of anxiety to examine the effects of anxiety and age on markers of emotion processing and cognitive control over emotion while undergoing MRI scanning. The authors found that more severe anxiety was associated with greater activation in the left ventrolateral prefrontal cortex, a region supporting cognitive control over emotion, which may prevent anxiety-related slowing of response times. Conversely, when participants were prompted to ignore emotional faces, anxiety severity was associated with slower performance and greater activation of the ventral attention network, suggesting greater stimulus-driven attention to emotional distractors. Age moderated associations between anxiety and brain activity during cognitive control over emotion, supporting the potential utility of tailoring interventions for anxiety.
Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety; https://clinicaltrials.gov; NCT02810171.
临床上焦虑的青少年对情绪刺激过度警觉，并且在将注意力从情绪刺激转移到非情绪刺激方面存在困难，这表明在对情绪的认知控制方面存在缺陷。然而，尚不清楚这种偏差的神经基础在焦虑的临床到非临床范围内或是否因年龄而异。
年龄在7至17岁之间的患有临床焦虑症（n = 119）或无焦虑症诊断（n = 41）的青少年在磁共振成像过程中匹配情绪面孔或匹配形状，并在其两侧伴有情绪面孔干扰物，分别探测情绪加工和对情绪的认知控制。基于美国国立精神卫生研究所研究领域标准（RDoC）框架，对临床焦虑的青少年按诊断类别进行抽样，对未受临床影响的青少年按最小到亚临床严重程度进行抽样。
在两种情况下，焦虑严重程度均与右顶下叶过度激活有关，右顶下叶是过度警觉的一个神经基础。脑 - 焦虑关联也因注意力状态而异；焦虑严重程度与情绪加工（面孔匹配）期间左侧腹外侧前额叶皮层更大的激活以及在对情绪的认知控制（形状匹配）期间左侧颞上沟后部和颞顶交界处更大的激活（以及反应较慢）有关。年龄也调节了焦虑与对情绪的认知控制之间的关联，因此焦虑与较年幼和中等年龄儿童的右侧丘脑和双侧后扣带回皮层更大的激活有关，但与年龄较大的青少年无关。
与刺激驱动的对情绪干扰物的注意力相关的脑区功能异常可能导致青少年焦虑。结果支持针对发育阶段量身定制的焦虑注意力调节干预措施的潜在效用。
对威胁的优先关注是一种检测危险的适应性机制，在临床上焦虑的青少年中被夸大。本研究纳入了150名年龄在7至17岁之间、涵盖焦虑临床 - 非临床范围的青少年，以检查焦虑和年龄对情绪加工标记物以及在进行MRI扫描时对情绪的认知控制的影响。作者发现，更严重的焦虑与左侧腹外侧前额叶皮层更大的激活有关，该区域支持对情绪的认知控制，这可能防止与焦虑相关的反应时间减慢。相反，当参与者被提示忽略情绪面孔时，焦虑严重程度与表现较慢以及腹侧注意力网络更大的激活有关，这表明对情绪干扰物有更大的刺激驱动注意力。年龄调节了在对情绪的认知控制期间焦虑与脑活动之间的关联，支持针对焦虑量身定制干预措施的潜在效用。
儿科焦虑症中CBT结果的维度脑行为预测因素；https://clinicaltrials.gov；NCT02810171。
