A Functional Magnetic Resonance Imaging Investigation of Uncertainty in Adolescents with Anxiety Disorders

New York University Child Study Center, New York University School of Medicine, New York, NY 10016, USA.
Biological psychiatry (Impact Factor: 10.26). 04/2008; 63(6):563-8. DOI: 10.1016/j.biopsych.2007.06.011
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Pediatric anxiety disorders, although highly prevalent, are understudied with little known about their pathophysiology. Intolerance of uncertainty (IU) is a trait associated with worry, a key characteristic of these disorders. Neural responses to uncertainty in healthy subjects involve the same frontal-limbic circuits that are hyper-responsive in pediatric anxiety. As such, the present study examines the relationship between IU and neural responses to uncertainty in anxious adolescents.
Sixteen adolescents (ages 13-17) diagnosed with generalized anxiety disorder and/or social phobia (ANX) and 13 non-anxious control subjects completed a decision-making task while functional magnetic resonance imaging scans were acquired.
The ANX group endorsed greater task-related anxiety and less certainty than control subjects on a post-task questionnaire. Compared with control subjects, the ANX group did not demonstrate hyper-responsivity of brain regions as hypothesized. Across groups, IU was positively correlated with activity in several frontal and limbic regions. Further analyses identified subgroups within the ANX group: those with high IU activated frontal/limbic regions, whereas those with low IU and less anxiety during the task deactivated the same regions in response to uncertainty.
Results substantiate the hypothesized link between IU and neural responses to uncertainty in some adolescents with anxiety disorders. Our findings, if replicated, suggest that trait measures, such as IU, can significantly improve our understanding of the neurobiological basis of pediatric anxiety disorders.

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    • "Intolerance of uncertainty is linked with anger expression in individuals with generalized anxiety disorder and may explain why they may disengage from tasks or avoid decision making (Fracalanza, Koerner, Deschenes, & Dugas, 2014). It appears that intolerance to uncertainty is positively correlated with activity in frontolimbic areas, particularly in subgroups of people with social or generalized anxiety (Krain et al., 2008). "
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    • "ry group was found , with HW having longer reaction times to all picture conditions compared to LW . A possible explanation is that HW had increased cognitive evaluative processing when confronted with the stimulus material , resulting in longer reaction times . While earlier studies of uncertainty found no group differ - ences for reaction time ( Krain et al . , 2008 ; Yassa et al . , 2012 ) these data suggest that ambiguity may be an important part of uncer - tainty in a broader sense which has been largely neglected so far ."
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