Insula reactivity and connectivity to anterior cingulate cortex when processing threat in generalized social anxiety disorder

► There is evidence of exaggerated insula reactivity to threat in social anxiety. ► Aberrant insula-prefrontal interactions may underlie social anxiety. ► We examined insula-prefrontal functional connectivity in social anxiety. ► Socially anxious subjects showed insula hyper-reactivity to fear versus happy faces. ► Socially anxious subjects had less insula-anterior cingulate coupling than controls.