title: Reduced dorsal anterior cingulate cortical activity during emotional regulation and top-down attentional control in generalized social phobia, generalized anxiety disorder, and comorbid generalized social phobia/generalized anxiety disorder.
abstract: BACKGROUND
  Generalized social phobia (GSP) and generalized anxiety disorder (GAD) are both associated with emotion dysregulation. Research implicates dorsal anterior cingulate cortex in both explicit emotion regulation (EER) and top-down attentional control (TAC). Although studies have examined these processes in GSP or GAD, no work compares findings across the two disorders or examines functioning in cases comorbid for both disorders (GSP/GAD). Here we compare the neural correlates of EER and TAC in GSP, GAD, and GSP/GAD.
  
  
  METHODS
  Medication-free adults with GSP (EER n = 19; TAC n = 18), GAD (EER n = 17; TAC n = 17), GSP/GAD (EER n = 17; TAC n = 15), and no psychopathology (EER n = 18; TAC n = 18) participated. During EER, individuals alternatively viewed and upregulated and downregulated responses to emotional pictures. During TAC, they performed an emotional Stroop task.
  
  
  RESULTS
  For both tasks, significant group × condition interactions emerged in dorsal anterior cingulate cortex and parietal cortices. Healthy adults showed significantly increased recruitment during emotion regulation, relative to emotion-picture viewing. GAD, GSP, and GSP/GAD subjects showed no such increases, with all groups differing from healthy adults but not from each other. Evidence of emotion-related disorder-specificity emerged in medial prefrontal cortex and amygdala. This disorder-specific responding varied as a function of emotion content but not emotion-regulatory demands.
  
  
  CONCLUSIONS
  GSP and GAD both involve reduced capacity for engaging emotion-regulation brain networks, whether explicitly or via TAC. A reduced ability to recruit regions implicated in top-down attention might represent a general risk factor for anxiety disorders.
authors.affiliation: National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA. peschark@mail.nih.gov
authors.forename: Karina S
authors.initials: KS
authors.lastname: Blair
authors.forename: Marilla
authors.initials: M
authors.lastname: Geraci
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Smith
authors.forename: Nick
authors.initials: N
authors.lastname: Hollon
authors.forename: Jeffrey
authors.initials: J
authors.lastname: DeVido
authors.forename: Marcela
authors.initials: M
authors.lastname: Otero
authors.forename: James R
authors.initials: JR
authors.lastname: Blair
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Pine
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000503:physiopathology*; D001288:Attention / Q000502:physiology*; D015897:Comorbidity; D004644:Emotions / Q000502:physiology*; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology*; D012307:Risk Factors; D057190:Stroop Test