Neural correlates of the emotional Stroop task in panic disorder patients: an event-related fMRI study

Although being a standard tool to assess interference effects of disorder-specific words in clinical samples, the neural underpinnings of the emotional Stroop task are still not well understood and have hardly been investigated in experimental case-control studies. We therefore used functional magnetic resonance imaging (fMRI) to examine the attentional bias toward panic-related words in panic disorder (PD) patients and healthy controls. Twenty PD patients (with or without agoraphobia) and 23 healthy controls matched for age and gender performed an event-related emotional Stroop task with panic-related and neutral words while undergoing 3 Tesla fMRI. On the behavioral level, PD patients showed a significant emotional Stroop effect, i.e. color-naming of panic-related words was prolonged compared to neutral words. This effect was not observed in the control group. PD patients further differed from controls on the neural level in showing increased BOLD activity in the left inferior frontal gyrus in response to panic-related relative to neutral words. PD patients showed the expected attentional bias, i.e. an altered processing of disorder-specific stimuli. This emotional Stroop effect was paralleled by increased activation in the left prefrontal cortex which may indicate altered processing of emotional stimulus material.