Prefrontoparietal dysfunction during emotion regulation in anxiety disorder: a meta-analysis of functional magnetic resonance imaging studies

Abstract

Objective

Impairments in emotion regulation, and more specifically in cognitive reappraisal, are thought to play a key role in the pathogenesis of anxiety disorders. However, the available evidence on such deficits is inconsistent. To further illustrate the neurobiological underpinnings of anxiety disorder, the present meta-analysis summarizes functional magnetic resonance imaging (fMRI) findings for cognitive reappraisal tasks and investigates related brain areas.

Methods

We performed a comprehensive series of meta-analyses of cognitive reappraisal fMRI studies contrasting patients with anxiety disorder with healthy control (HC) subjects, employing an anisotropic effect-size signed differential mapping approach. We also conducted a subgroup analysis of medication status, anxiety disorder subtype, data-processing software, and MRI field strengths. Meta-regression was used to explore the effects of demographics and clinical characteristics. Eight studies, with 11 datasets including 219 patients with anxiety disorder and 227 HC, were identified.

Results

Compared with HC, patients with anxiety disorder showed relatively decreased activation of the bilateral dorsomedial prefrontal cortex (dmPFC), bilateral dorsal anterior cingulate cortex (dACC), bilateral supplementary motor area (SMA), left ventromedial prefrontal cortex (vmPFC), bilateral parietal cortex, and left fusiform gyrus during cognitive reappraisal. The subgroup analysis, jackknife sensitivity analysis, heterogeneity analysis, and Egger’s tests further confirmed these findings.

Conclusions

Impaired cognitive reappraisal in anxiety disorder may be the consequence of hypo-activation of the prefrontoparietal network, consistent with insufficient top-down control. Our findings provide robust evidence that functional impairment in prefrontoparietal neuronal circuits may have a significant role in the pathogenesis of anxiety disorder.

Keywords:

• anxiety disorder
• emotion regulation
• cognitive reappraisal
• fMRI
• prefrontoparietal network
• signed differential mapping

Supplementary materials

Table S1 Imaging methodology quality assessment checklist (when criteria were partially met, 0.5 points were assigned)

Table S2 Sensitivity analyses of task-based fMRI studies of regional differences in activation in patients with anxiety disorder compared with healthy controls

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Acknowledgments

The authors wish to thank all investigators who have provided additional information regarding their studies upon our request. This work was supported by National Natural Science Foundation of China (grant no. 81401486) and the Natural Science Foundation of Shandong Province of China (ZR2015HL039).

Author contributions

Hai-Yang Wang was the main author of this study and participated in the conception and design of the study, literature search, methods, analysis and manuscript write-up; Xiao-Xia Zhang, Cui-Ping Si, Yang Xu, Qian Liu, He-Tao Bian, and Bing-Wei Zhang contributed to reviewing studies, extracting data and feedback on analysis; Xue-Lin Li and Zhong-Rui Yan, corresponding authors, participated in the design of the study, analysis and interpretation of data. All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.