Spatiotemporal responses to emotional conflict and its psychiatric correlates in adolescents with epilepsy using magnetoencephalography.

People with epilepsy often suffer from comorbid psychiatric disorders, which negatively affects their quality of life. Emotion regulation is an important cognitive process that is impaired in individuals with psychiatric disorders, such as depression. Adults with epilepsy also show difficulties in emotion regulation, particularly during later-stage, higher-order cognitive processing. Yet, the spatiotemporal and frequency correlates of these functional brain deficits in epilepsy remain unknown, as do the nature of these deficits in adolescent epilepsy. Here, we aim to elucidate the spatiotemporal profile of emotional conflict processing in adolescents with epilepsy, relative to controls, using magnetoencephalography (MEG) and relate these findings to anxiety and depression symptom severity assessed with self-report scales. We hypothesized to see blunted brain activity during emotional conflict in adolescents with epilepsy, relative to controls, in the posterior parietal, prefrontal and cingulate cortices due to their role in explicit and implicit regulation around participant response (500-1000 ms). We analyzed MEG recordings from 53 adolescents (28 epilepsy [14focal,14generalized], 25 controls) during an emotional conflict task. We showed that while controls exhibited behavioral interference to emotional conflict, adolescents with epilepsy failed to exhibit this normative response time pattern. Adolescents with epilepsy showed blunted brain responses to emotional conflict in brain regions related to error evaluation and learning around the average response time (500-700 ms), and in regions involved in decision making during post-response monitoring (800-1000 ms). Interestingly, behavioral patterns and psychiatric symptom severity varied between epilepsy subgroups, wherein those with focal epilepsy showed preserved response time interference. Thus, brain responses were regressed with depression and anxiety levels for each epilepsy subgroup separately. Analyses revealed that under activation in error evaluation regions (500-600 ms) predicted anxiety and depression in focal epilepsy, while regions related to learning (600-700 ms) predicted anxiety in generalized epilepsy, suggesting differential mechanisms of dysfunction in these subgroups. Despite similar rates of anxiety and depression across the groups, adolescents with epilepsy still exhibited deficits in emotional conflict processing in brain and behavioral responses. This suggests that these deficits may exist independently from psychopathology and may stem from underlying dysfunctions that predispose these individuals to develop both disorders. Findings such as these may provide potential targets for future research and therapies.

Reliability of a functional magnetic resonance imaging task of emotional conflict in healthy participants.

Task-based functional neuroimaging methods are increasingly being used to identify biomarkers of treatment response in psychiatric disorders. To facilitate meaningful interpretation of neural correlates of tasks and their potential changes with treatment over time, understanding the reliability of the blood-oxygen-level dependent (BOLD) signal of such tasks is essential. We assessed test-retest reliability of an emotional conflict task in healthy participants collected as part of the Canadian Biomarker Integration Network in Depression. Data for 36 participants, scanned at three time points (weeks 0, 2, and 8) were analyzed, and intra-class correlation coefficients (ICC) were used to quantify reliability. We observed moderate reliability (median ICC values between 0.5 and 0.6), within occipital, parietal, and temporal regions, specifically for conditions of lower cognitive complexity, that is, face, congruent or incongruent trials. For these conditions, activation was also observed within frontal and sub-cortical regions, however, their reliability was poor (median ICC < 0.2). Clinically relevant prognostic markers based on task-based fMRI require high predictive accuracy at an individual level. For this to be achieved, reliability of BOLD responses needs to be high. We have shown that reliability of the BOLD response to an emotional conflict task in healthy individuals is moderate. Implications of these findings to further inform studies of treatment effects and biomarker discovery are discussed.

The human body odor compound androstadienone increases neural conflict coupled to higher behavioral costs during an emotional Stroop task.

The androgen derivative androstadienone (AND) is a substance found in human sweat and thus may act as human chemosignal. With the current experiment, we aimed to explore in which way AND affects interference processing during an emotional Stroop task which used human faces as target and emotional words as distractor stimuli. This was complemented by functional magnetic resonance imaging (fMRI) to unravel the neural mechanism of AND-action. Based on previous accounts we expected AND to increase neural activation in areas commonly implicated in evaluation of emotional face processing and to change neural activation in brain regions linked to interference processing. For this aim, a total of 80 healthy individuals (oral contraceptive users, luteal women, men) were tested twice on two consecutive days with an emotional Stroop task using fMRI. Our results suggest that AND increases interference processing in brain areas that are heavily recruited during emotional conflict. At the same time, correlation analyses revealed that this neural interference processing was paralleled by higher behavioral costs (response times) with higher interference related brain activation under AND. Furthermore, AND elicited higher activation in regions implicated in emotional face processing including right fusiform gyrus, inferior frontal gyrus and dorsomedial cortex. In this connection, neural activation was not coupled to behavioral outcome. Furthermore, despite previous accounts of increased hypothalamic activation under AND, we were not able to replicate this finding and discuss possible reasons for this discrepancy. To conclude, AND increased interference processing in regions heavily recruited during emotional conflict which was coupled to higher costs in resolving emotional conflicts with stronger interference-related brain activation under AND. At the moment it remains unclear whether these effects are due to changes in conflict detection or resolution. However, evidence most consistently suggests that AND does not draw attention to the most potent socio-emotional information (human faces) but rather highlights representations of emotional words.

Different effects of levodopa and subthalamic stimulation on emotional conflict in Parkinson's disease.

Parkinson's disease impairs the decoding of emotional stimuli reflecting alterations of the limbic cortico-subcortical network. The objective of this study was to assess and compare the behavioral and electrophysiological effects of both levodopa and subthalamic stimulation on emotional processing in Parkinson's disease. Operated patients (n =16) and matched healthy subjects performed an emotional Stroop task, in which the emotion expressed by a face must be recognized while ignoring an emotional distractive word and that includes a neutral control sub-task. Patients were tested in the four possible treatment conditions (off stim/off med; on stim/off med; off stim/on med; and on stim/on med). High-resolution electroencephalography was recorded while performing the task. Patients made significantly more mistakes in facial emotion recognition than healthy subjects (p < .005). Untreated patients performed worse in the emotional trials than in the control sub-task (p < .05). Fearful faces induced significantly slower reaction times than happy faces in patients (p = .0002), but not in the healthy subjects. The emotional Stroop effect with levodopa was significantly higher than with subthalamic stimulation when fearful faces were assessed (p = .0243). Conversely, treatments did not modulate the Stroop effect of the control sub-task. EEG demonstrated that, compared with the untreated state, levodopa but not subthalamic stimulation significantly increases the amplitude of the event-related potential N170 (p = .002 vs. p = .1, respectively), an electrophysiological biomarker of early aspects of facial processing. The activity of the N170 cortical sources within the right fusiform gyrus was increased by levodopa (p < .05) but not by stimulation. While levodopa normalizes the recognition of emotional facial expression and early EEG markers of emotional processing, subthalamic stimulation does not. Thus, operated patients require dopaminergic medication in addition to stimulation to treat emotional symptoms of Parkinson's disease.

Positive emotion impedes emotional but not cognitive conflict processing.

Cognitive control enables successful goal-directed behavior by resolving a conflict between opposing action tendencies, while emotional control arises as a consequence of emotional conflict processing such as in irony. While negative emotion facilitates both cognitive and emotional conflict processing, it is unclear how emotional conflict processing is affected by positive emotion (e.g., humor). In 2 EEG experiments, we investigated the role of positive audiovisual target stimuli in cognitive and emotional conflict processing. Participants categorized either spoken vowels (cognitive task) or their emotional valence (emotional task) and ignored the visual stimulus dimension. Behaviorally, a positive target showed no influence on cognitive conflict processing, but impeded emotional conflict processing. In the emotional task, response time conflict costs were higher for positive than for neutral targets. In the EEG, we observed an interaction of emotion by congruence in the P200 and N200 ERP components in emotional but not in cognitive conflict processing. In the emotional conflict task, the P200 and N200 conflict effect was larger for emotional than neutral targets. Thus, our results show that emotion affects conflict processing differently as a function of conflict type and emotional valence. This suggests that there are conflict- and valence-specific mechanisms modulating executive control.

Subgenual Cingulum Microstructure Supports Control of Emotional Conflict.

Major depressive disorder (MDD) is associated with specific difficulties in attentional disengagement from negatively valenced material. Diffusion MRI studies have demonstrated altered white matter microstructure in the subgenual cingulum bundle (CB) in individuals with MDD, though the functional significance of these alterations has not been examined formally. This study explored whether individual differences in selective attention to negatively valenced stimuli are related to interindividual differences in subgenual CB microstructure. Forty-six individuals (21 with remitted MDD, 25 never depressed) completed an emotional Stroop task, using happy and angry distractor faces overlaid by pleasant or unpleasant target words and a control gender-based Stroop task. CBs were reconstructed in 38 individuals using diffusion-weighted imaging and tractography, and mean fractional anisotropy (FA) computed for the subgenual, retrosplenial, and parahippocampal subdivisions. No significant correlations were found between FA and performance in the control gender-based Stroop task in any CB region. However, the degree of interference produced by angry face distractors on time to identify pleasant words (emotional conflict) correlated selectively with FA in the subgenual CB (r = -0.53; P = 0.01). Higher FA was associated with reduced interference, irrespective of a diagnosis of MDD, suggesting that subgenual CB microstructure is functionally relevant for regulating attentional bias toward negative interpersonal stimuli.

Amplitude of low-frequency oscillations associated with emotional conflict control.

Previous fMRI studies related to emotional conflict focused on task activation during the specific experimental paradigm. Yet, the underlying spontaneous neural activity was largely unknown. Here, this was the first study using resting-state fMRI to explore the spontaneous neural activity related to emotional conflict. We used the whole-brain analysis to investigate the association between emotional conflict and amplitude of low-frequency fluctuations (ALFF) in a large sample. We found that the emotional conflict effect was negatively correlated with ALFF in the right AMY. These findings implied that AMY was the key region which plays a crucial role in emotional conflict.

The time course of attentional modulation on emotional conflict processing.

Cognitive conflict resolution is critical to human survival in a rapidly changing environment. However, emotional conflict processing seems to be particularly important for human interactions. This study examined whether the time course of attentional modulation on emotional conflict processing was different from cognitive conflict processing during a flanker task. Results showed that emotional N200 and P300 effects, similar to colour conflict processing, appeared only during the relevant task. However, the emotional N200 effect preceded the colour N200 effect, indicating that emotional conflict can be identified earlier than cognitive conflict. Additionally, a significant emotional N100 effect revealed that emotional valence differences could be perceived during early processing based on rough aspects of input. The present data suggest that emotional conflict processing is modulated by top-down attention, similar to cognitive conflict processing (reflected by N200 and P300 effects). However, emotional conflict processing seems to have more time advantages during two different processing stages.

Effect of trait anxiety on prefrontal control mechanisms during emotional conflict.

Converging evidence points to a link between anxiety proneness and altered emotional functioning, including threat-related biases in selective attention and higher susceptibility to emotionally ambiguous stimuli. However, during these complex emotional situations, it remains unclear how trait anxiety affects the engagement of the prefrontal emotional control system and particularly the anterior cingulate cortex (ACC), a core region at the intersection of the limbic and prefrontal systems. Using an emotional conflict task and functional magnetic resonance imaging (fMRI), we investigated in healthy subjects the relations between trait anxiety and both regional activity and functional connectivity (psychophysiological interaction) of the ACC. Higher levels of anxiety were associated with stronger task-related activation in ACC but with reduced functional connectivity between ACC and lateral prefrontal cortex (LPFC). These results support the hypothesis that when one is faced with emotionally incompatible information, anxiety leads to inefficient high-order control, characterized by insufficient ACC-LPFC functional coupling and increases, possibly compensatory, in activation of ACC. Our findings provide a deeper understanding of the pathophysiology of the neural circuitry underlying anxiety and may offer potential treatment markers for anxiety disorders.

Effects of contextualized emotional conflict control on domain-general conflict control: fMRI evidence of neural network reconfiguration.

Domain-general conflict control refers to the cognitive process in which individuals suppress task-irrelevant information and extract task-relevant information. It supports both effective implementation of cognitive conflict control and emotional conflict control. The present study employed functional magnetic resonance imaging and adopted an emotional valence conflict task and the arrow version of the flanker task to induce contextualized emotional conflicts and cognitive conflicts, respectively. The results from the conjunction analysis showed that the multitasking-related activity in the pre-supplementary motor area, bilateral dorsal premotor cortices, the left posterior intraparietal sulcus (IPS), the left anterior IPS and the right inferior occipital gyrus represents common subprocesses for emotional and cognitive conflict control, either in parallel or in close succession. These brain regions were used as nodes in the domain-general conflict control network. The results from the analyses on the brain network connectivity patterns revealed that emotional conflict control reconfigures the domain-general conflict control network in a connective way as evidenced by different communication and stronger connectivity among the domain-general conflict control network. Together, these findings offer the first empirical-based elaboration on the brain network underpinning emotional conflict control and how it reconfigures the domain-general conflict control network in interactive ways.

Temporal characteristics of emotional conflict processing: the modulation role of attachment styles.

Theoretical account of attachment proposed that individual differences in adult attachment styles play a key role in adjusting balance between affective evaluation and cognitive control. Yet, little is known about the temporal characteristics of emotional conflict processing modulated by attachment styles. Accordingly, the present study used event-related potentials (ERP) and multivariate pattern analysis (MVPA) combined with an emotional face-word Stroop task to investigate the temporal dynamics of attachment-related cognitive-affective patterns in emotional conflict processing. The ERP results demonstrated multiple-process of emotional conflict modulated by attachment styles. In early sensory processing, positive faces captured avoidant attachment individuals' attention as reflected in greater P1, while the same situation led to greater N170 in secure and anxious individuals. Crucially, impairment in conflict-monitoring function was found in anxious individuals as reflected by the absence of interference effect on N450, leading to impaired ability of inhibitory control as indicated by decreased slow potential. In contrast, avoidant individuals showed greater slow potential for inhibiting emotional interference. Furthermore, MVPA revealed that the corresponding time window for conflict monitoring was found for emotional distractors decoding rather than congruency decoding in the anxious attachment group. Convergent results from ERPs and MVPA indicated that the deficits in emotional conflict monitoring and resolution among anxious individuals might be due to the excessive approach to emotional distractors, as they habitually use emotional evaluation rather than cognitive control. In summary, the present study provides electrophysiological evidence that attachment styles modulated emotional conflict processing, which highlights the contribution of attachment to social information processing.

Proactive and reactive cognitive control for emotional conflict in individuals with high schizotypy: An ERP study.

OBJECTIVE: The present study aimed to examine how individuals with high schizotypy, a high risk group of schizophrenia patients, resolve emotional conflict in proactive and reactive control and the underlying neural mechanisms. METHODS: Thirty-two individuals with high schizotypy and 30 matched individuals with low schizotypy completed an emotional face-word Stroop task with electroencephalographic data recorded. The proportion of incongruent trials was manipulated in the task to induce proactive control (mostly incongruent trials context, MI context) or reactive control (mostly congruent trials context, MC context). Two event-related potential (ERP) components (N170 and N2) were examined, which represent face processing and cognitive control processes, respectively. RESULTS: In the MC context, significantly decreased N2 and N170 amplitudes were found in high schizotypy individuals compared with low schizotypy individuals, suggesting abnormal neural activity of reactive control in high schizotypy individuals. No significant differences were found between the two groups in the MI context. CONCLUSIONS: These results provide initial evidence for dissociation of neural activity of proactive and reactive control on emotional conflict in individuals with high schizotypy. SIGNIFICANCE: The current findings provide important insight into the emotional conflict resolution in the schizophrenia spectrum.

The neural correlates of emotional conflict monitoring as an early manifestation of affective and cognitive declines in persons with Type 2 diabetes.

Patients with Type 2 diabetes are known to be more susceptible to experience dementia and depression/anxiety. The neural circuits of emotional conflict monitoring, as indicated by a Stroop task, might become altered in terms of cognitive and affective impairments in diabetes. This study investigated alterations in the emotional conflict monitoring and associations of corresponding brain activities with metabolic parameters in persons with Type 2 diabetes. Participants with normal cognitive and affective functioning, including 40 persons with Type 2 diabetes and 30 non-diabetes control subjects, underwent a functional MRI paradigm with the face-word emotional Stroop task and detailed cognitive and affective assessments, including the Montreal Cognitive Assessment and Beck Anxiety Inventory. Compared with the controls, people with diabetes exhibited stronger emotional interference, as indicated by differential reaction times between congruent and incongruent trials (Δcon). Δcon was correlated with Montreal Cognitive Assessment test scores and fasting glucose levels. People with diabetes demonstrated altered brain activation and functional connectivity in the neural network for emotional conflict monitoring. The neural network for emotional conflict monitoring mediated the association of pancreatic function with anxiety scores as well as the relationship between Δcon and Montreal Cognitive Assessment scores. Results suggested that alterations in the neural network underlying emotional conflict monitoring might present before clinically measurable cognitive and affective decrements were apparent, thereby bridging the gap between dementia and anxiety/depression in persons with diabetes.

The importance of informal support and a listening ear: A narrative analysis of emotional conflict and support needs of siblings of children with a psychiatric disorder.

This study investigates the self-reported impact of children's psychiatric disorders on their siblings and assesses what forms of support such children most value. We used a qualitative research design with open interviews to stimulate children between 8 and 15 years old to talk about their experiences living with a brother or sister with a psychiatric disorder. Their stories were analysed within a hermeneutic phenomenological framework in order to identify narrative themes and interpret the meaning of shared experiences. From our analysis, nine shared narrative themes emerge. Overall, siblings report feeling conflicted about adapting their lives to their brother's or sister's disorder and signal a need for personalized attention from parents. They also indicate that being involved in the care for their brother or sister helps them to better understand their behaviour. Finally, siblings reveal that, in their experience, formal, protocolized forms of support foreground family problems and stress. Thus, we recommend to involve children in the care process; to acknowledge their personal needs and conflicts; and to be mindful of the style of support: help offered in an informal or playful way, instead of formal and protocolized, could be a more effective way of meeting siblings' needs.

fMRI reveals overlapping and non-overlapping neural bases of domain-general and emotional conflict control.

The present study uses functional magnetic resonance image (fMRI) to examine the overlapping and specific neural correlates of contextualized emotional conflict control and domain-general conflict control. During a performance on emotional and domain-general conflict tasks, conjunction analyses showed that neural areas distributed in the frontoparietal network were engaged in both processes, supporting the notion that similar neural mechanisms are implemented in these two types of control. Importantly, disjunction analyses revealed a broader neural recruitment of emotional conflict control compared to domain-general conflict control as shown by the possible lateralization of the lateral prefrontal cortex (lPFC), such that emotional conflict control significantly involved the left lPFC while domain-general conflict control seemly involved the right lPFC. Results of generalized psychophysiological interaction (gPPI) analyses further demonstrated that emotional conflict control, compared to domain-general conflict control, elicited broader synergistic activities in individuals' brain networks. Together, these findings offer novel and compelling neural evidence that furthers our understanding of the complex relationship between domain-general and emotional conflict control.

Affective Dysregulation in Children Is Associated With Difficulties in Response Control in Emotional Ambiguous Situations.

BACKGROUND: Affective dysregulation (AD), or synonymously "irritability," is a transdiagnostic construct that serves as a diagnostic criterion in various childhood mental disorders. It is characterized by severe or persistent outbursts of anger and aggression. Emotional self-regulation is highly dependent on the ability to process relevant and ignore conflicting emotional information. Understanding neurophysiological mechanisms underlying impairment in AD may provide a starting point for research on pharmacological treatment options and evaluation of psychotherapeutic intervention. METHODS: A total of 120 children 8 to 12 years of age (63 with AD and 57 typically developing) were examined using an emotional Stroop task. Signal-decomposed electroencephalographic recordings providing information about the affected sensory-perceptual, response selection, or motor information processing stage were combined with source localization. RESULTS: Behavioral performance revealed dysfunctional cognitive-emotional conflict monitoring in children with AD, suggesting difficulties in differentiating between conflicting and nonconflicting cognitive-emotional information. This was confirmed by the electroencephalographic data showing that they cannot intensify response selection processes during conflicting cognitive-emotional situations. Typically developing children were able to do so and activated a functional-neuroanatomical network comprising the left inferior parietal cortex (Brodmann area 40), right middle frontal (Brodmann area 10), and right inferior/orbitofrontal (Brodmann area 47) regions. Purely sensory-perceptual selection and motor execution processes were not modulated in AD, as evidenced by Bayesian analyses. CONCLUSIONS: Behavioral and electroencephalogram data suggest that children with AD cannot adequately modulate controlled response selection processes given emotionally ambiguous information. Which neurotransmitter systems underlie these deficits and how they can be improved are important questions for future research.

Attention bias modification through transcranial direct current stimulation (tDCS): A review.

Attention bias is a tendency to preferably detect, orient and select emotionally valued stimuli, as compared to neutral stimuli, and plays a crucial role in the psychopathology of various psychiatric disorders. Transcranial direct current stimulation (tDCS) has been applied for the alteration of attention bias in health and disease with different parameters and conditions, but the contribution of these factors to the magnitude and directionality of effects has not previously been comprehensively reviewed. In this review, we aimed to systematically explore the effects of tDCS on attention bias in different tasks, tDCS conditions, and health states. Data were collected in accordance with the PRISMA approach. A literature search identified 22 original experiments that explored the effects of tDCS on attention bias. Determinants of tDCS effects on attention bias were cortical target areas, the specific task under study, stimulation parameters, and the presence of psychopathology. Relevant cortical areas for modification of attention bias via tDCS were the dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC). The observed heterogeneity of the impact of tDCS on the modulation of attention bias can be explained by the area of stimulation, valence of stimuli, task characteristics, and the intensity of stimulation.

The role of arousal and motivation in emotional conflict resolution: Implications for spinal cord injury.

Under many conditions, emotional information is processed with priority and it may lead to cognitive conflict when it competes with task-relevant information. Accordingly, being able to ignore emotional information relies on cognitive control. The present perspective offers an integrative account of the mechanism that may underlie emotional conflict resolution in tasks involving response activation. We point to the contribution of emotional arousal and primed approach or avoidance motivation in accounting for emotional conflict resolution. We discuss the role of arousal in individuals with impairments in visceral pathways to the brain due to spinal cord lesions, as it may offer important insights into the "typical" mechanisms of emotional conflict control. We argue that a better understanding of emotional conflict control could be critical for adaptive and flexible behavior and has potential implications for the selection of appropriate therapeutic interventions.

The role of the dorsolateral and ventromedial prefrontal cortex in emotion regulation in females with major depressive disorder (MDD): A tDCS study.

BACKGROUND: Individuals with major depressive disorder (MDD) have deficits in emotion regulation, which plays a putative role in psychopathology. The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are assumed to be involved in respective processes. In the present study, we aimed to explore the effect of stimulation over the dlPFC and vmPFC on emotion regulation in female with MDD. MATERIAL AND METHODS: Twenty women with MDD performed the Emotional Stroop, Emotional Go/No-Go, and Emotional 1-Back tasks during transcranial direct current stimulation (tDCS) in three separate sessions with the following electrode montages: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. RESULTS: Independent of the valence of the respective stimuli, accuracy and speed of interference control, accuracy of pre-potent inhibition, and accuracy, but not speed, of working memory performance improved during anodal left dlPFC/cathodal right vmPFC stimulation. Independent of stimulation conditions, interference control was reduced for sad faces, as compared to happy and neutral faces, and working memory performance was faster for happy than for neutral and sad faces. For the impact of stimulation on specific emotional qualities, anodal left dlPFC/cathodal right vmPFC, compared to sham stimulation, led to improved interference control of sad and neutral faces in the emotional Stroop task, as shown by faster reaction times. Furthermore, in that task accuracy with respect to neutral and happy face conditions was higher during both real stimulation conditions, as compared to sham stimulation. CONCLUSION: The dlPFC is involved in emotion regulation in MDD. Emotional valence is moreover relevant for the effect of stimulation over this area on interference control in MDD.

Incongruence effects in cross-modal emotional processing in autistic traits: An fMRI study.

In everyday life, emotional information is often conveyed by both the face and the voice. Consequently, information presented by one source can alter the way in which information from the other source is perceived, leading to emotional incongruence. Here, we used functional magnetic resonance imaging (fMRI) to examine neutral correlates of two different types of emotional incongruence in audiovisual processing, namely incongruence of emotion-valence and incongruence of emotion-presence. Participants were in two groups, one group with a low Autism Quotient score (LAQ) and one with a high score (HAQ). Each participant experienced emotional (happy, fearful) or neutral faces or voices while concurrently being exposed to emotional (happy, fearful) or neutral voices or faces. They were instructed to attend to either the visual or auditory track. The incongruence effect of emotion-valence was characterized by activation in a wide range of brain regions in both hemispheres involving the inferior frontal gyrus, cuneus, superior temporal gyrus, and middle frontal gyrus. The incongruence effect of emotion-presence was characterized by activation in a set of temporal and occipital regions in both hemispheres, including the middle occipital gyrus, middle temporal gyrus and inferior temporal gyrus. In addition, the present study identified greater recruitment of the right inferior parietal lobule in perceiving audio-visual emotional expressions in HAQ individuals, as compared to the LAQ individuals. Depending on face or voice-to-be attended, different patterns of emotional incongruence were found between the two groups. Specifically, the HAQ group tend to show more incidental processing to visual information whilst the LAQ group tend to show more incidental processing to auditory information during the crossmodal emotional incongruence decoding. These differences might be attributed to different attentional demands and different processing strategies between the two groups.