目的:临床上焦虑的年轻人对情绪刺激过度警惕,难以将注意力从情绪刺激转移到非情绪刺激,提示认知控制对情绪的损害。然而,目前尚不清楚这种偏倚的神经底物是否在焦虑的临床与非临床范围内变化,还是因年龄而异.
方法:7-17岁有临床焦虑(N=119)或没有焦虑诊断(N=41)的青少年在磁共振成像过程中与情绪面部干扰物匹配的情绪面部或匹配的形状,探测情绪处理和对情绪的认知控制,分别。从国家精神卫生研究所的研究领域标准框架构建,临床焦虑的年轻人被纳入诊断类别,在最小至亚临床严重程度范围内对未受临床影响的青少年进行采样.
结果:在这两种情况下,与右下顶叶过度激活相关的焦虑严重程度,高度警惕的基质。大脑焦虑的关联也通过注意状态来区分;焦虑的严重程度与情绪处理(面部匹配)过程中左腹外侧前额叶皮层的更大激活以及在认知控制情绪(形状匹配)过程中左上颞沟和颞顶交界处的更大激活(以及较慢的反应)相关。年龄也调节了焦虑和对情绪的认知控制之间的关联,因此,对于年龄较小和平均年龄的儿童,焦虑与更大的右丘脑和双侧后扣带皮质激活相关,但不适合年长的年轻人。
结论:大脑区域的异常功能与刺激驱动的对情绪分散者的注意力有关,可能会导致青少年焦虑。结果支持针对发育阶段量身定制的焦虑注意力调节干预措施的潜在效用。
OBJECTIVE: Clinically anxious youth are hypervigilant to emotional stimuli and display difficulty shifting attention from emotional to nonemotional stimuli, suggesting impairments in cognitive control over emotion. However, it is unknown whether the neural substrates of such biases vary across the clinical-to-nonclinical range of anxiety or by age.
METHODS: Youth aged 7 to 17 years with clinical anxiety (n = 119) or without an anxiety diagnosis (n = 41) matched emotional faces or matched shapes flanked by emotional face distractors during magnetic resonance imaging, probing emotion processing and cognitive control over emotion, respectively. Building from the National Institute of Mental Health Research Domain Criteria (RDoC) framework, clinically anxious youth were sampled across diagnostic categories, and non-clinically affected youth were sampled across minimal-to-subclinical severity.
RESULTS: Across both conditions, anxiety severity was associated with hyperactivation in the right inferior parietal lobe, a substrate of hypervigilance. Brain-anxiety associations were also differentiated by attentional state; anxiety severity was associated with greater left ventrolateral prefrontal cortex activation during emotion processing (face matching) and greater activation in the left posterior superior temporal sulcus and temporoparietal junction (and slower responses) during cognitive control over emotion (shape matching). Age also moderated associations between anxiety and cognitive control over emotion, such that anxiety was associated with greater right thalamus and bilateral posterior cingulate cortex activation for children at younger and mean ages, but not for older youth.
CONCLUSIONS: Aberrant function in brain regions implicated in stimulus-driven attention to emotional distractors may contribute to anxiety in youth. Results support the potential utility of attention modulation interventions for anxiety that are tailored to developmental stage.
BACKGROUND: Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety; https://clinicaltrials.gov; NCT02810171.