An Insular View of Anxiety

doi:10.1016/j.biopsych.2006.03.042

Biological Psychiatry

Volume 60, Issue 4, 15 August 2006, Pages 383-387

https://doi.org/10.1016/j.biopsych.2006.03.042 Get rights and content

We propose a general hypothesis that integrates affective and cognitive processing with neuroanatomy to explain anxiety pronenes. The premise is that individuals who are prone to anxiety show an altered interoceptive prediction signal, i.e., manifest augmented detection of the difference between the observed and expected body state. As a consequence, the increased prediction signal of a prospective aversive body state triggers an increase in anxious affect, worrisome thoughts and other avoidance behaviors. The anterior insula is proposed to play a key role in this process. Further testing of this model—which should include investigation of genetic and environmental influences—may lead to the development of novel treatments that attenuate this altered interoceptive prediction signal in patients with anxiety disorders.

Section snippets

Interoception

Interoception can be defined as the sense of the physiological condition of the entire body (Craig 2002). Interoceptive information includes sensations such as temperature, pain, itch, tickle, sensual touch, muscular and visceral sensations, vasomotor flush, hunger, thirst, air hunger and others. Interoception has long been thought to be critical for self-awareness because it provides the link between cognitive and affective processes and the current body state. The neural system that underlies

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Neuroscience perspectiveAn Insular View of Anxiety

Section snippets

Interoception

J Behav Ther Exp Psychiatry

Trends Cogn Sci

Behav Brain Res

Behav Res Ther

Psychiatry Res

Neuroimage

Biol Psychiatry