Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock.
Assessing the role of the amygdala in fear of pain: Neural activation under threat of shock.
复制标题
评估杏仁核在恐惧疼痛中的作用：休克威胁下的神经激活。
DOI：
10.1016/j.jad.2020.07.110
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发表时间：
2020
影响因子：
6.6
通讯作者：
Bradley,MargaretM
中科院分区：
文献类型：
--
作者：
Sambuco,Nicola;Costa,VincentD;Lang,PeterJ;Bradley,MargaretM
简介DSM-5 明确指出特定恐惧症的神经系统模型以杏仁核为中心。然而，这一假设主要得到人类对动物恐惧症的研究的支持，而其他特定恐惧症（例如牙齿恐惧症）的视觉提示并不总是显示杏仁核激活。考虑到对预期疼痛的恐惧是牙科恐惧症的最佳预测因素之一，当前的研究调查了对牙痛恐惧程度不同的个体中疼痛预期的神经和自主活动。方法对女性（n = 31）进行了功能性大脑活动（fMRI）测量，这些女性被选为在受到电击威胁时自我报告的对牙痛恐惧程度不同的女性，其中一种颜色表示可能会受到痛苦的电击，另一种颜色表示安全。与安全性相比，在受到威胁时的功能活动在前岛叶和前/中扣带皮层等区域被发现。重要的是，前岛叶的威胁反应性随着报告的对疼痛的恐惧增加而增加，并进一步预测了疼痛预期期间皮肤电导的变化。局限性样本由女性组成。结论对疼痛的恐惧的个体差异随着前岛叶的激活而变化，而不是随着杏仁核的激活而变化，这表明恐惧并不是唯一与杏仁核激活相关的。尽管人们发现情绪调节等应对技术在面对视觉线索时会随着额叶杏仁核回路的激活而变化，但精准精神病学可能需要针对特定的大脑回路来诊断和治疗不同类型的特定恐惧症。
IntroductionThe DSM-5 explicitly states that the neural system model of specific phobia is centered on the amygdala. However, this hypothesis is predominantly supported by human studies on animal phobia, whereas visual cuing of other specific phobias, such as dental fear, do not consistently show amygdala activation. Considering that fear of anticipated pain is one of the best predictors of dental phobia, the current study investigated neural and autonomic activity of pain anticipation in individuals varying in the degree of fear of dental pain.MethodFunctional brain activity (fMRI) was measured in women (n= 31) selected to vary in the degree of self-reported fear of dental pain when under the threat of shock, in which one color signaled the possibility of receiving a painful electric shock and another color signaled safety.ResultsEnhanced functional activity during threat, compared to safety, was found in regions including anterior insula and anterior/mid cingulate cortex. Importantly, threat reactivity in the anterior insula increased as reported fear of pain increased and further predicted skin conductance changes during pain anticipation.LimitationsThe sample was comprised of women.ConclusionsIndividual differences in fear of pain vary with activation in the anterior insula, rather than with the amygdala, indicating that fear is not uniquely associated with amygdala activation. Whereas coping techniques such as emotion regulation have been found to vary with activation in a frontal-amygdala circuit when confronted with visual cues, precision psychiatry may need to target specific brain circuits to diagnose and treat different types of specific phobia.