Striatal–limbic activation is associated with intensity of anticipatory anxiety

Anxiety experienced in anticipation of impending aversive events induces striatal–limbic activation. However, previous functional magnetic imaging (fMRI) studies of anticipatory anxiety have utilized post-test measures of anxiety, making a direct association between neural activation and distress problematic. This paradigm was designed to assess the blood-oxygen-level-dependent (BOLD) response to an aversive conditioned stimulus while simultaneously measuring subjective anxiety. Fifteen male healthy subjects (45.5±8.5 years old) were studied. A high-threat conditioned stimulus (CS) was paired with either an unpredictable, highly aversive (painful) or non-aversive (non-painful) unconditioned stimulus and compared to a low-threat CS paired with a predictable, non-aversive stimulus. Neural response was assessed with fMRI, and subjective anxiety (1–4) was recorded upon the presentation of each CS. High subjective ratings of real-time anticipatory anxiety (2–4), relative to low anticipatory anxiety (1), elicited increased activation in the bilateral striatum, bilateral orbital frontal cortex, left anterior insula, and anterior cingulate cortex (ACC) and decreased activation in the posterior cingulate cortex (PCC). The amplitude of BOLD signal change generally paralleled the subjective rating of anxiety. Real-time measures of anticipatory anxiety confirm previous reports, using post-test measures of anxiety, of striatal–limbic activation during anticipatory anxiety while simultaneously demonstrating an increase in BOLD response in parallel with heightened anxiety.