Anxious individuals shift emotion control from lateral frontal pole to dorsolateral prefrontal cortex

Why anxious individuals fail to control emotional behaviour is not well understood. Here, the authors show that highly anxious individuals have a more excitable lateral frontopolar cortex, and fail to recruit this region during emotional action control. Anxious individuals consistently fail in controlling emotional behavior, leading to excessive avoidance, a trait that prevents learning through exposure. Although the origin of this failure is unclear, one candidate system involves control of emotional actions, coordinated through lateral frontopolar cortex (FPl) via amygdala and sensorimotor connections. Using structural, functional, and neurochemical evidence, we show how FPl-based emotional action control fails in highly-anxious individuals. Their FPl is overexcitable, as indexed by GABA/glutamate ratio at rest, and receives stronger amygdalofugal projections than non-anxious male participants. Yet, high-anxious individuals fail to recruit FPl during emotional action control, relying instead on dorsolateral and medial prefrontal areas. This functional anatomical shift is proportional to FPl excitability and amygdalofugal projections strength. The findings characterize circuit-level vulnerabilities in anxious individuals, showing that even mild emotional challenges can saturate FPl neural range, leading to a neural bottleneck in the control of emotional action tendencies.

Automated summary

It is not well understood why anxious individuals fail to control emotional behaviour. This study shows that highly anxious individuals have an overexcitable lateral frontopolar cortex (FPl) and do not recruit this region during emotional action control. Their FPl is overexcitable and receives stronger amygdalofugal projections, but fails to be recruited during emotional action control, leading to a functional anatomical shift to other prefrontal areas.