Brief report Anterior cingulate cortex involvement in subclinical social anxiety Elizabeth R. Duval a,b,n , Lisa R. Hale b,c , Israel Liberzon a , Rebecca Lepping d , Joshua N. Powell e , Diane L. Filion b , Cary R. Savage e a Department of Psychiatry, University of Michigan Health System, 4250 Plymouth Road, Ann Arbor, MI 48109, USA b Department of Psychology, University of Missouri–Kansas City, Kansas City, MO, USA c Kansas City Center for Anxiety Treatment, Overland Park, KS, USA d Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA e Center for Health Behavior Neuroscience, University of Kansas Medical Center, Kansas City, KS, USA article info Article history: Received 20 March 2013 Received in revised form 21 August 2013 Accepted 9 September 2013 Keywords: fMRI Backward masking Faces abstract We demonstrated differential activation in the anterior cingulate cortex (ACC) between subjects with high and low social anxiety in response to angry versus neutral faces. Activation in the ACC distinguished between facial expressions in the low, but not the high, anxious group. The ACC's role in threat processing is discussed. & 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Reduced activation and connectivity in the anterior cingulate cortex (ACC), an area involved in attention/emotion modulation (Bishop, 2008) has been implicated in social anxiety disorder (Klumpp et al., 2012). However, ACC also shows increased activa- tion during threat processing in social anxiety (Amir et al., 2005), suggesting the ACC may have multiple roles in stimulus proces- sing, perhaps responding to stimulus salience early, and/or mod- ulating attention/emotion after conscious awareness. Previous studies however have mainly focused on supraliminal processing in ACC, thus little is known regarding the role of the ACC in face processing prior to conscious awareness. Backward masking tech- niques have been used to investigate early, subconscious face processing (Whalen et al., 1998). However, no studies to date have examined these effects in regard to social anxiety symptoms. The purpose of this study was to use backward masking to investigate ACC activation during face processing in adults with high and low levels of social anxiety. Two competing hypotheses were tested: (1) consistent with Klumpp et al. (2012), ACC activation would be reduced in people with high social anxiety symptoms in response to threat, indicating a deficit in attention/emotion modulation; or (2) consistent with Amir et al. (2005), ACC activation would be increased in people with high social anxiety symptoms in response to threat, indicating increased salience processing. 2. Method 2.1. Subjects Subjects were recruited from a larger study (N¼55) examining attentional and emotional responses to subliminally presented affective faces in social anxiety, to be reported elsewhere. 477 subjects were screened with the Social Interaction Anxiety Scale (SIAS; Mattick and Clarke, 1989), and those scoring in the top and bottom 10% were assigned to the high social anxiety and low social anxiety groups respectively. All subjects were right handed with normal hearing and eyesight (naturally or corrected), no history of head injury/concussion, seizures, or stroke, and were not receiving treatment for psychiatric conditions per self report. The Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) was administered by a trained clinician to assess psychiatric symptoms. Individuals meeting criteria for any psychiatric disorder, including social anxiety disorder, were not eligible to participate. Nineteen of the original 55 subjects were eligible and consented for the current study. Eighteen (nine high social anxiety symptoms, nine low social anxiety symptoms) were retained for final analysis. Subjects were all female college students with an age range of 18–32 (high social anxiety M¼20.4, S.D. ¼3.9, low social anxiety M¼23.9, S.D. ¼4.0). Groups did not differ by age, t(16) ¼À1.92, p 40.05. 2.2. Procedures All of the procedures were approved by the Institutional Review Boards at the University of Kansas Medical Center and University of Missouri–Kansas City. Prior to participating in the study, all subjects provided written informed consent. Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychresns Psychiatry Research: Neuroimaging 0925-4927/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pscychresns.2013.09.005 n Corresponding author at: Department of Psychiatry, University of Michigan Health System, 4250 Plymouth Road, Ann Arbor, MI 48109, USA. Tel.: þ1 734 936 4397. E-mail address: eduval@med.umich.edu (E.R. Duval). Psychiatry Research: Neuroimaging 214 (2013) 459–461