Making a mountain out of a molehill: on the role of the rostral dorsal anterior cingulate and dorsomedial prefrontal cortex in conscious threat appraisal, catastrophizing, and worrying

According to appraisal theories fear and anxiety are elicited by the subjective evaluation of a situation or internal state as threatening. From this perspective anxiety disorders result from maladaptive, exaggerated threat appraisals that over-estimate the threatening consequences of often innocuous stimuli and situations. When these threat over-estimations occur at the level of conscious processing, they are referred to as catastrophizing and worrying. Both are major pathogenic processes in many clinical theories of anxiety. Until recently, little has been known about the neurobiological basis of normal and pathological conscious threat appraisal. Here, we review functional neuroimaging studies which draw a consistent picture of the rostral part of the dorsal anterior cingulate (dACC) and the adjacent dorsomedial prefrontal cortex (dmPFC) as the likely key neural substrate of conscious threat appraisal. Moreover, findings of hyper-activation of the rostral dACC/dmPFC during catastrophizing and worrying emphasize its relevance to aberrant neural processing in anxiety disorders. These insights open a new avenue for improving the prevention and treatment of mental disorders that involve pathological appraisal.