title: Cough Is Dangerous: Neural Correlates of Implicit Body Symptoms Associations.
abstract: The negative interpretation of body sensations (e.g., as sign of a severe illness) is a crucial cognitive process in pathological health anxiety (HA). However, little is known about the nature and the degree of automaticity of this interpretation bias. We applied an implicit association test (IAT) in 20 subjects during functional magnetic resonance imaging (fMRI) to investigate behavioral and neural correlates of implicit attitudes toward symptom words. On the behavioral level, body symptom words elicited strong negative implicit association effects, as indexed by slowed reaction times, when symptom words were paired with the attribute "harmless" (incongruent condition). fMRI revealed increased activation in the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex for the comparison of incongruent words with control words, as well as with a lower significance threshold also in comparison to congruent words. Moreover, activation in the DLPFC, posterior parietal cortex, nucleus accumbens, and cerebellum varied with individual levels of HA (again, in comparison to control words, as well as with a lower significance threshold also in comparison to congruent words). Slowed reaction times as well as increased activation in dorsolateral prefrontal and posterior parietal cortex point to increased inhibitory demands during the incongruent IAT condition. The positive association between HA severity and neural activity in nucleus accumbens, dorsolateral prefrontal, and posterior parietal cortex suggests that HA is characterized by both intensified negative implicit attitudes and hampered cognitive control mechanisms when confronted with body symptoms.
authors.affiliation: Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mier
authors.affiliation: Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Witthöft
authors.affiliation: Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Bailer
authors.affiliation: Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Ofer
authors.affiliation: Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kerstner
authors.affiliation: Department of Clinical Psychology, University of Münster Germany.
authors.forename: Fred
authors.initials: F
authors.lastname: Rist
authors.affiliation: Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergGermany; School of Applied Psychology, SRH University of Applied SciencesHeidelberg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Diener
keywords: executive functions; functional magnetic resonance imaging; health anxiety; implicit association test; prefrontal cortex