There is more than the amygdala: potential threat assessment in the cingulate cortex

Fear conditioning with its neurological basis in the amygdala and associated structures provides an important model of anxiety disorders. However, this review will argue for a distinction between fear-provoking immediate and anxiety-provoking potential threats, with the amygdala processing immediate threats and the cingulate cortex (and insular) processing potential threats. Four independent but related literatures are reviewed to bolster this argument: (1) rodent remote contextual fear conditioning, (2) symptom provocation in obsessive compulsive disorder (OCD), (3) fMRI investigations of risk assessment, and (4) behavioural and neurological studies of precautionary reasoning. These four literatures converge in suggesting that the cingulate cortex (and in more specific instances the insula) underlie potential threat assessment, providing support for a number of recent models posting the existence of a separate potential threat system that is dysfunctional in obsessive compulsive disorder (e.g., Szechtman and Woody, 2004; Woody and Szechtman, 2011).