There is more than the amygdala: potential threat assessment in the cingulate cortex

Abstract

Fear conditioning with its neurological basis in the amygdala and associated structures provides an important model of anxiety disorders. However, this review will argue for a distinction between fear-provoking immediate and anxiety-provoking potentialthreats, with the amygdala processing immediate threats and the cingulatecortex (and insular) processing potentialthreats. Four independent but related literatures are reviewed to bolster this argument: (1) rodent remote contextual fear conditioning, (2) symptom provocation in obsessive compulsive disorder (OCD), (3) fMRI investigations of risk assessment, and (4) behavioural and neurological studies of precautionary reasoning. These four literatures converge in suggesting that the cingulatecortex (and in more specific instances the insula) underlie potentialthreatassessment, providing support for a number of recent models posting the existence of a separate potentialthreat system that is dysfunctional in obsessive compulsive disorder (e.g., [Szechtman and Woody, 2004] and [Woody and Szechtman, 2011]).