Volitional control of anterior insula activity modulates the response to aversive stimuli. A real-time functional magnetic resonance imaging study

Background: A promising new approach to cognitive neuroscience based on real-time functional magnetic resonance imaging (rtfMRI) demonstrated that the learned regulation of the neurophysiological activity in circumscribed brain regions can be used as an independent variable to observe its effects on behavior. Here, for the first time, we investigated the modulatory effect of learned regulation of blood oxygenation level-dependent (BOLD) response in the left anterior insula on the perception of visual emotional stimuli. Methods: Three groups of participants (n27) were tested: two underwent four rtfMRI training sessions receiving either specific (n9) or unspecific feedback (n9) of the insula’s BOLD response, respectively, and one group used emotional imagery alone (n9) without rtfMRI feedback. During training, all groups were required to assess aversive and neutral pictures. Results: Participants able to significantly increase BOLD signal in the target region rated the aversive pictures more negatively. We measured a significant correlation between enhanced left anterior insula activity and increased negative valence ratings of the aversive stimuli. Control groups performing either rtfMRI training with unspecific feedback or an emotional imagery training alone were not able to significantly enhance activity in the left anterior insula and did not show changes in subjective emotional responses. Conclusions: This study corroborates traditional neuroimaging studies demonstrating a critical role of the anterior insula in the explicit appraisal of emotional stimuli and indicates the adopted approach as a potential tool for clinical applications in emotional disorders.