Background: Health anxiety (HA) is defined as the objectively unfounded fear or conviction of suffering from a severe illness. Predominant attention allocation to illness-related information is regarded as a central process in the development and maintenance of HA, yet little is known about the neuronal correlates of this attentional bias. Methods: An emotional Stroop task with body symptom, illness, and neutral words was employed to elicit emotional interference in healthy participants with high (HA+, n = 12) and low (HA–, n = 12) HA during functional magnetic resonance imaging. Results: Prolonged reaction times for indicating the color of symptom words and a decrease in rostral anterior cingulate cortex (rACC) activation were seen in HA+ participants. Emotional interference effects on the behavioral level were negatively related to rACC activity over the whole group. Groups did not differ during the processing of threatening illness words. Conclusion: The results indicate stronger attention allocation toward body symptom words already in subclinical HA. This attentional bias appears to be linked to hypoactivity of the rACC which impedes effective emotional interference reduction, leading instead to a ruminative processing of the stimulus content.

Ferguson E: A taxometric analysis of health anxiety. Psychol Med 2009;39:277–285.
Longley SL, Broman-Fulks JJ, Calamari JE, Noyes R, Wade M, Orlando CM: A taxometric study of hypochondriasis symptoms. Behav Ther 2010;41:505–514.
Witthoft M, Hiller W: Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol 2010;6:257–283.
APA: Diagnostic and Statistical Manual of Mental Disorders – DSM-IV-TR, ed 4. Washington, American Psychiatric Association, 2000.
WHO: ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th rev, ed 2. Geneva, WHO, 2005.
Warwick HM, Salkovskis PM: Hypochondriasis. Behav Res Ther 1990;28:105–117.
Marcus DK, Gurley JR, Marchi MM, Bauer C: Cognitive and perceptual variables in hypochondriasis and health anxiety: a systematic review. Clin Psychol Rev 2007;27:127–139.
Owens KM, Asmundson GJG, Hadjistavropoulos T, Owens TJ: Attentional bias toward illness threat in individuals with elevated health anxiety. Cogn Ther Res 2004;28:57–66.
Witthoft M, Rist F, Bailer J: Enhanced early emotional intrusion effects and proportional habituation of threat response for symptom and illness words in college students with elevated health anxiety. Cogn Ther Res 2008;32:818–842.
Lecci L, Cohen D: Altered processing of health threat words as a function of hypochondriacal tendencies and experimentally manipulated control beliefs. Cogn Emot 2007;21:211–224.
Karademas EC, Christopoulou S, Dimostheni A, Pavlu F: Health anxiety and cognitive interference: evidence from the application of a modified Stroop task in two studies. Pers Indiv Differ 2008;44:1138–1150.
Williams PG: The psychopathology of self-assessed health: a cognitive approach to health anxiety and hypochondriasis. Cogn Ther Res 2004;28:629–644.
Lees A, Mogg K, Bradley BP: Health anxiety, anxiety sensitivity, and attentional biases for pictorial and linguistic health-threat cues. Cogn Emot 2005;19:453–462.
Jasper F, Witthoft M: Health anxiety and attentional bias: the time course of vigilance and avoidance in light of pictorial illness information. J Anxiety Disord 2011;25:1131–1138.
Algom D, Chajut E, Lev S: A rational look at the emotional Stroop phenomenon: a generic slowdown, not a Stroop effect. J Exp Psychol Gen 2004;133:323–338.
Williams JM, Mathews A, MacLeod C: The emotional Stroop task and psychopathology. Psychol Bull 1996;120:3–24.
Weierich MR, Treat TA, Hollingworth A: Theories and measurement of visual attentional processing in anxiety. Cogn Emot 2008;22:985–1018.
Schmukle SC: Unreliability of the dot-probe task. Eur J Pers 2005;19:595–605.
Bar-Haim Y, Lamy D, Pergamin L, Bakermans-Kranenburg MJ, van IJzendoorn MH: Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychol Bull 2007;133:1–24.
Isenberg N, Silbersweig D, Engelien A, Emmerich S, Malavade K, Beattie B, Leon AC, Stern E: Linguistic threat activates the human amygdala. Proc Natl Acad Sci USA 1999;96:10456–10459.
Compton RJ, Banich MT, Mohanty A, Milham MP, Herrington J, Miller GA, Scalf PE, Webb A, Heller W: Paying attention to emotion: an FMRI investigation of cognitive and emotional Stroop tasks. Cogn Affect Behav Neurosci 2003;3:81–96.
Whalen PJ, Bush G, McNally RJ, Wilhelm S, McInerney SC, Jenike MA, Rauch SL: The emotional counting Stroop paradigm: a functional magnetic resonance imaging probe of the anterior cingulate affective division. Biol Psychiatry 1998;44:1219–1228.
Etkin A, Egner T, Peraza DM, Kandel ER, Hirsch J: Resolving emotional conflict: a role for the rostral anterior cingulate cortex in modulating activity in the amygdala. Neuron 2006;51:871–882.
Egner T, Etkin A, Gale S, Hirsch J: Dissociable neural systems resolve conflict from emotional versus nonemotional distracters. Cereb Cortex 2008;18:1475–1484.
Johansen-Berg H, Gutman DA, Behrens TEJ, Matthews PM, Rushworth MFS, Katz E, Lozano AM, Mayberg HS: Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression. Cereb Cortex 2008;18:1374–1383.
Pezawas L, Meyer-Lindenberg A, Drabant EM, Verchinski BA, Munoz KE, Kolachana BS, Egan MF, Mattay VS, Hariri AR, Weinberger DR: 5-HTTLPR polymorphism impacts human cingulate-amygdala interactions: a genetic susceptibility mechanism for depression. Nat Neurosci 2005;8:828–834.
Anand A, Li Y, Wang Y, Wu JW, Gao SJ, Bukhari L, Mathews VP, Kalnin A, Lowe MJ: Activity and connectivity of brain mood regulating circuit in depression: a functional magnetic resonance study. Biol Psychiatry 2005;57:1079–1088.
George MS, Ketter TA, Parekh PI, Rosinsky N, Ring H, Casey BJ, Trimble MR, Horwitz B, Herscovitch P, Post RM: Regional brain activity when selecting a response despite interference: an H215O PET study of the Stroop and an emotional Stroop. Hum Brain Mapp 1994;1:194–209.
Miller GA, Mohanty A, Engels AS, Herrington JD, Heller W, Ho MHR, Banich MT, Webb AG, Warren SL: Differential engagement of anterior cingulate cortex subdivisions for cognitive and emotional function. Psychophysiology 2007;44:343–351.
Canli T, Sivers H, Thomason ME, Whitfield-Gabrieli S, Gabrieli JD, Gotlib IH: Brain activation to emotional words in depressed versus healthy subjects. Neuroreport 2004;15:2585–2588.
Haas BW, Omura K, Constable RT, Canli T: Interference produced by emotional conflict associated with anterior cingulate activation. Cogn Affect Behav Neurosci 2006;6:152–156.
Van den Heuvel OA, Veltman DJ, Groenewegen HJ, Witter MP, Merkelbach I, Cath DC, van Balkom AJLM, van Oppen P, van Dyck R: Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. Arch Gen Psychiatry 2005;62:922–933.
Bishop S, Duncan J, Brett M, Lawrence AD: Prefrontal cortical function and anxiety: controlling attention to threat-related stimuli. Nat Neurosci 2004;7:184–188.
Friederich HC, Brooks S, Uher R, Campbell IC, Giampietro V, Brammer M, Williams SC, Herzog W, Treasure J: Neural correlates of body dissatisfaction in anorexia nervosa. Neuropsychologia 2010;48:2878–2885.
Klumpp H, Ho SS, Taylor SF, Phan KL, Abelson JL, Liberzon I: Trait anxiety modulates anterior cingulate activation to threat interference. Depress Anxiety 2011;28:194–201.
Most SB, Chun MM, Johnson MR, Kiehl KA: Attentional modulation of the amygdala varies with personality. Neuroimage 2006;31:934–944.
Lefaivre MJ, Watt MC, Stewart SH, Wright KD: Implicit associations between anxiety-related symptoms and catastrophic consequences in high anxiety sensitive individuals. Cogn Emot 2006;20:295–308.
Hiller W, Rief W: Internationale Skalen für Hypochondrie. Deutschsprachige Adaptation des Whiteley-Index (WI) und der Illness Attitude Scales (IAS) (German version of the Whiteley-Index and the illness attitude scales). Bern, Huber, 2004.
Hiller W, Rief W, Fichter MM: Dimensional and categorical approaches to hypochondriasis. Psychol Med 2002;32:707–718.
Kroenke K, Spitzer RL, Williams JB: The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002;64:258–266.
Spitzer RL, Williams JB, Kroenke K: Prime MD Today. Evaluation of Mental Disorders. Manual. USA, Pfizer US, 1999.
Lowe B, Kroenke K, Herzog W, Grafe K: Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004;81:61–66.
Barsky AJ, Coeytaux RR, Sarnie MK, Cleary PD: Hypochondriacal patients’ beliefs about good health. Am J Psychiatry 1993;150:1085–1089.
Yovel I, Mineka S: Emotion-congruent attentional biases: the perspective of hierarchical models of emotional disorders. Pers Indiv Differ 2005;38:785–795.
Rauch SL, Shin LM, Phelps EA: Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research – past, present, and future. Biol Psychiatry 2006;60:376–382.
Klumpp H, Ho SS, Taylor SF, Phan KL, Abelson JL, Liberzon I: Trait anxiety modulates anterior cingulate activation to threat interference. Depress Anxiety 2011;28:194–201.
Etkin A, Wager TD: Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry 2007;164:1476–1488.
Polli FE, Barton JJS, Cain MS, Thakkar KN, Rauch SL, Manoach DS: Rostral and dorsal anterior cingulate cortex make dissociable contributions during antisaccade error commission. Proc Natl Acad Sci USA 2005;102:15700–15705.
Marcus DK, Hughes KT, Arnau RC: Health anxiety, rumination, and negative affect: a mediational analysis. J Psychosom Res 2008;64:495–501.
Witthöft M, Stübinger C, Rist F, Bailer J: Is ‘headache’ automatically bad? Automatic affective evaluations of symptom and illness words in college students with elevated health anxiety. Under Review.
Gilboa-Schechtman E, Revelle W, Gotlib IH: Stroop interference following mood induction: emotionality, mood congruence, and concern relevance. Cogn Ther Res 2000;24:491–502.
Ferguson E, Moghaddam NG, Bibby PA: Memory bias in health anxiety is related to the emotional valence of health-related words. J Psychosom Res 2007;62:263–274.
Wenzlaff EM, Wegner DM: Thought suppression. Annu Rev Psychol 2000;51:59–91.
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