Linking subjective experience of anxiety to brain function using natural language processing

Research on anxiety focuses on clinically relevant behaviours and neurophysiological responses, particularly emphasizing recruitment of amygdala, insula, and cingulate cortex. Whether these same circuits instantiate subjective experience of anxiety remains unclear, a vital hurdle for clinical neuroscience. We used a semi-naturalistic, anxiogenic stimulus (animated movie) to evoke anxiety during fMRI in a pediatric sample with and without anxiety disorders (N = 84, before exclusion). After, participants provided verbal responses to interview questions about the stimulus. We quantified semantic content and valence of responses via natural language processing algorithms. Preregistered analyses found that wide-spread brain activity during the movie-including in the anterior insula cortex-related to participants' descriptions of the movie's narrative. Secondary analyses indicated anxiety symptoms were associated with insula responses, participants' descriptions of the movie's narrative, and appraisals. This study provides preliminary evidence that anxiety symptoms may shape patterns of insula activity during movie-watching, influencing the type of notable details later recalled. These findings underscore the utility of movie viewing paradigms in clinical neuroscience research on subjective emotional experiences in anxiety.