title: Elevated amygdala activity during reappraisal anticipation predicts anxiety in avoidant personality disorder.
abstract: BACKGROUND
  Avoidant personality disorder is characterized by pervasive anxiety, fear of criticism, disapproval, and rejection, particularly in anticipation of exposure to social situations. An important but underexplored question concerns whether anxiety in avoidant patients is associated with an impaired ability to engage emotion regulatory strategies in anticipation of and during appraisal of negative social stimuli.
  
  
  METHODS
  We examined the use of an adaptive emotion regulation strategy, cognitive reappraisal, in avoidant patients. In addition to assessing individual differences in state and trait anxiety levels, self-reported affect as well as measures of neural activity were compared between 17 avoidant patients and 21 healthy control participants both in anticipation of and during performance of a reappraisal task.
  
  
  RESULTS
  Avoidant patients showed greater state and trait-related anxiety relative to healthy participants. In addition, relative to healthy participants, avoidant patients showed pronounced amygdala hyper-reactivity during reappraisal anticipation, and this hyper-reactivity effect was positively associated with increasing self-reported anxiety levels.
  
  
  CONCLUSIONS
  Our finding of exaggerated amygdala activity during reappraisal anticipation could reflect anxiety about the impending need to reappraise, anxiety about the certainty of an upcoming negative image, or anxiety relating to anticipated scrutiny of task responses by the experimenters. While we believe that all of these possibilities are consistent with the phenomenology of avoidant personality disorder, future research may clarify this ambiguity.
  
  
  CONCLUSIONS
  These results suggest that amygdala reactivity in anticipation of receiving negative social information may represent a key component of the neural mechanisms underlying the heightened anxiety present in avoidant patients.
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Denny
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Psychology, Queens College, City University of New York, New York, NY 11367, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Fan
authors.affiliation: Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Psychology, Columbia University, New York, NY 10027, USA.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Ochsner
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Guerreri
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Sarah Jo
authors.initials: SJ
authors.lastname: Mayson
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Liza
authors.initials: L
authors.lastname: Rimsky
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Antonia
authors.initials: A
authors.lastname: McMaster
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; James J Peters VA Medical Center, Bronx, NY 10468, USA.
authors.forename: Antonia S
authors.initials: AS
authors.lastname: New
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; James J Peters VA Medical Center, Bronx, NY 10468, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; James J Peters VA Medical Center, Bronx, NY 10468, USA.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Siever
authors.affiliation: Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; James J Peters VA Medical Center, Bronx, NY 10468, USA. Electronic address: HWarrenK@nyc.rr.com.
authors.forename: Harold W
authors.initials: HW
authors.lastname: Koenigsberg
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology*; D001007:Anxiety / Q000175:diagnosis* / Q000503:physiopathology; D001008:Anxiety Disorders; D005239:Fear; D005260:Female; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000150:complications* / Q000503:physiopathology; D012929:Psychological Distance
keywords: Amygdala; Anticipation; Anxiety; Avoidant personality disorder; FMRI; Reappraisal