Neural correlates of emotional reactivity and regulation in youth with and without anxiety

Background: Youth with anxiety disorders struggle with managing emotions relative to peers, but the neural basis of this difference has not been examined. Methods: Youth (Mage=13.6; range=8-17) with (n=37) and without (n=24) anxiety disorders completed a cognitive reappraisal task while undergoing fMRI. Emotional reactivity and regulation, functional activation, and beta-series connectivity were compared across groups. Results: Groups did not differ on emotional reactivity or regulation. However, affect ratings and fronto-limbic activation after viewing aversive imagery (with and without regulation) were higher for anxious youth. Anxious youth did not demonstrate age-dependent changes in regulation, whereas regulation in control youth increased linearly. Stronger amygdala-vmPFC connectivity related to greater anxiety in control youth, but less anxiety in anxious youth. Stronger amygdala-frontal pole connectivity related to worse emotion regulation in control youth, but better emotion regulation in anxious youth. Conclusions: Anxious youth regulate when instructed, but this does not relate to age. Viewing aversive imagery related to heightened negative affect even after reappraisal, accompanied by higher fronto-limbic activation. Emotion dysregulation in youth anxiety disorders may stem from heightened emotionality and potent bottom-up neurobiological responses to aversive stimuli. Findings suggest the importance of treatments focused on both reducing initial emotional reactivity and bolstering regulatory capacity.