Cumulative semantic interference is blind to morphological complexity and originates at the conceptual level.

When naming a sequence of pictures of the same semantic category (e.g., furniture), response latencies systematically increase with each named category member. This cumulative semantic interference effect has become a popular tool to investigate the cognitive architecture of language production. However, not all processes underlying the effect itself are fully understood, including the question where the effect originates from. While some researchers assume the interface of the conceptual and lexical level as its origin, others suggest the conceptual-semantic level. The latter assumption follows from the observation that cumulative effects, namely cumulative facilitation, can also be observed in purely conceptual-semantic tasks. Another unanswered question is whether cumulative interference is affected by the morphological complexity of the experimental targets. In two experiments with the same participants and the same material, we investigated both of these issues. Experiment 1, a continuous picture naming task, investigated whether morphologically complex nouns (e.g., kitchen table) elicit identical levels of cumulative interference to morphologically simple nouns (e.g., table). Our results show this to be the case, indicating that cumulative interference is unaffected by lexical information such as morphological complexity. In Experiment 2, participants classified the same target objects as either man-made or natural. As expected, we observed cumulative facilitation. A separate analysis showed that this facilitation effect can be predicted by the individuals' effect sizes of cumulative interference, suggesting a strong functional link between the two effects. Our results thus point to a conceptual-semantic origin of cumulative semantic interference.

On the lexical representation(s) of compounds: A continuous picture naming study.

The lexical representation of compound words in speech production is still under debate. While most studies with healthy adult speakers suggest that a single lemma representation is active during compound production, data from neuropsychological studies point toward multiple representations, with activation of the compound's constituent lemmas in addition to the compound's lemma. This study exploits the cumulative semantic interference effect to investigate the lexical representation of compounds in speech production. In a continuous picture naming experiment, category membership was established through the compounds' first constituents (category animals: zebra crossing, pony tail, cat litter …), while the compounds themselves were not semantically related. Moreover, pictures depicting the compounds' first constituents (zebra, pony, cat …) were presented as a control condition. As expected, naming latencies within categories increased linearly with each additionally named category member when producing monomorphemic words, which is interpreted as increasing interference during lexical selection. Importantly, this cumulative semantic interference effect was also observed for compounds. This indicates that the lemmas of the compounds' first constituents were activated during compound production, causing interference due to their semantic relationship and thereby hampering the production of the whole compound. The results are thus in line with the multiple-lemma representation account (Marelli et al., 2012). We argue that the apparent contradiction between results of previous studies with healthy adult speakers and our current study can be explained by the different experimental paradigms used. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Aging affects steaks more than knives: Evidence that the processing of words related to motor skills is relatively spared in aging.

Lexical-processing declines are a hallmark of aging. However, the extent of these declines may vary as a function of different factors. Motivated by findings from neurodegenerative diseases and healthy aging, we tested whether 'motor-relatedness' (the degree to which words are associated with particular human body movements) might moderate such declines. We investigated this question by examining data from three experiments. The experiments were carried out in different languages (Dutch, German, English) using different tasks (lexical decision, picture naming), and probed verbs and nouns, in all cases controlling for potentially confounding variables (e.g., frequency, age-of-acquisition, imageability). Whereas 'non-motor words' (e.g., steak) showed age-related performance decreases in all three experiments, 'motor words' (e.g., knife) yielded either smaller decreases (in one experiment) or no decreases (in two experiments). The findings suggest that motor-relatedness can attenuate or even prevent age-related lexical declines, perhaps due to the relative sparing of neural circuitry underlying such words.

Morphological facilitation and semantic interference in compound production: An ERP study.

This study investigates the production of nominal compounds (Experiment 1) and simple nouns (Experiment 2) in a picture-word interference (PWI) paradigm to test models of morpho-lexical representation and processing. The continuous electroencephalogram (EEG) was registered and event-related brain potentials [ERPs] were analyzed in addition to picture-naming latencies. Experiment 1 used morphologically and semantically related distractor words to tap into different pre-articulatory planning stages during compound production. Relative to unrelated distractors, naming was speeded when distractors corresponded to morphemes of the compound (sun or flower for the target sunflower), but slowed when distractors were from the same semantic category as the compound (tulip ➔ sunflower). Distractors from the same category as the compound's first constituent (moon ➔ sunflower) had no influence. The diverging effects for semantic and morphological distractors replicate results from earlier studies. ERPs revealed different effects of morphological and semantic distractors with an interesting time course: morphological effects had an earlier onset. Comparable to the naming latencies, no ERP effects were obtained for distractors from the same semantic category as the compound's first constituent. Experiment 2 investigated the effectiveness of the latter distractors, presenting them with pictures of the compounds' first constituents (e.g., moon ➔ sun). Interference was confirmed both behaviorally and in the ERPs, showing that the absence of an effect in Experiment 1 was not due to the materials used. Considering current models of speech production, the data are best explained by a cascading flow of activation throughout semantic, lexical and morpho-phonological steps of speech planning.

Biological sex classification with structural MRI data shows increased misclassification in transgender women.

Transgender individuals (TIs) show brain-structural alterations that differ from their biological sex as well as their perceived gender. To substantiate evidence that the brain structure of TIs differs from male and female, we use a combined multivariate and univariate approach. Gray matter segments resulting from voxel-based morphometry preprocessing of N = 1753 cisgender (CG) healthy participants were used to train (N = 1402) and validate (20% holdout N = 351) a support-vector machine classifying the biological sex. As a second validation, we classified N = 1104 patients with depression. A third validation was performed using the matched CG sample of the transgender women (TW) application sample. Subsequently, the classifier was applied to N = 26 TW. Finally, we compared brain volumes of CG-men, women, and TW-pre/post treatment cross-sex hormone treatment (CHT) in a univariate analysis controlling for sexual orientation, age, and total brain volume. The application of our biological sex classifier to the transgender sample resulted in a significantly lower true positive rate (TPR-male = 56.0%). The TPR did not differ between CG-individuals with (TPR-male = 86.9%) and without depression (TPR-male = 88.5%). The univariate analysis of the transgender application-sample revealed that TW-pre/post treatment show brain-structural differences from CG-women and CG-men in the putamen and insula, as well as the whole-brain analysis. Our results support the hypothesis that brain structure in TW differs from brain structure of their biological sex (male) as well as their perceived gender (female). This finding substantiates evidence that TIs show specific brain-structural alterations leading to a different pattern of brain structure than CG-individuals.

Brain structural correlates of alexithymia in patients with major depressive disorder

Background: Alexithymia is a risk factor for major depressive disorder (MDD) and has been associated with diminished treatment response. Neuroimaging studies have revealed structural aberrations of the anterior cingulate cortex and the fusiform gyrus in healthy controls with high levels of alexithymia. The present study tried to corroborate and extend these results to patients with MDD compared with healthy controls. Methods: We investigated the relationship between alexithymia, depression and grey matter volume in 63 patients with MDD (mean age ± standard deviation = 42.43 yr ± 11.91; 33 female) and 46 healthy controls (45.35 yr ± 8.37; 22 female). We assessed alexithymia using the Toronto Alexithymia Scale. We conducted an alexithymia × group analysis of covariance; we used a region-of-interest approach, including the fusiform gyrus and anterior cingulate cortex, and conducted whole brain analysis using voxelbased morphometry. Results: Our analysis revealed a significant alexithymia × group interaction in the fusiform gyrus (left, pFWE = 0.031; right, pFWE = 0.010). Higher alexithymia scores were associated with decreased grey matter volume in patients with MDD (pFWE = 0.009), but with increased grey matter volume of the fusiform gyrus in healthy controls (pFWE = 0.044). We found no significant main effects in the region-of-interest analysis. Limitations: Owing to the naturalistic nature of our study, patients with MDD and healthy controls differed significantly in their alexithymia scores. Conclusion: Our results showed the fusiform gyrus as a correlate of alexithymia. We also found differences related to alexithymia between patients with MDD and healthy controls in the fusiform gyrus. Our study encourages research related to the transition from risk to MDD in people with alexithymia.

Correction: Disentangling semantic and response learning effects in color-word contingency learning.

[This corrects the article DOI: 10.1371/journal.pone.0212714.].

Disentangling semantic and response learning effects in color-word contingency learning.

It is easier to indicate the ink color of a color-neutral noun when it is presented in the color in which it has frequently been shown before, relative to print colors in which it has been shown less often. This phenomenon is known as color-word contingency learning. It remains unclear whether participants actually learn semantic (word-color) associations and/or response (word-button) associations. We present a novel variant of the paradigm that can disentangle semantic and response learning, because word-color and word-button associations are manipulated independently. In four experiments, each involving four daily sessions, pseudowords-such as enas, fatu or imot-were probabilistically associated with either a particular color, a particular response-button position, or both. Neutral trials without color-pseudoword association were also included, and participants' awareness of the contingencies was manipulated. The data showed no influence of explicit contingency awareness, but clear evidence both for response learning and for semantic learning, with effects emerging swiftly. Deeper processing of color information, with color words presented in black instead of color patches to indicate response-button positions, resulted in stronger effects, both for semantic and response learning. Our data add a crucial piece of evidence lacking so far in color-word contingency learning studies: Semantic learning effectively takes place even when associations are learned in an incidental way.

The effects of processing speed on memory impairment in patients with major depressive disorder.

OBJECTIVE: Learning and memory performance have been reported to be impaired in patients with Major Depressive Disorder (MDD). Impairments are associated with diminished psychosocial functioning. Based on the processing-speed theory, we aimed to examine whether processing speed mediates the relationship between depression status and verbal, visuo-spatial and working memory impairment. METHODS: A neuropsychological test-battery was administered to 106 patients with current MDD, 119 patients with remitted MDD and 120 healthy controls to assess processing speed, learning and memory performance. To examine the impact of diagnosis status and processing speed on learning and memory performance, simple mediation models were computed. RESULTS: Currently depressed patients with MDD showed partially slowed processing speed, impaired short-term verbal and visuo-spatial memory performance compared to healthy controls. A basic deficit in processing speed mediated the relationship between depression status and verbal, visuo-spatial, and working memory impairment. However, there was no processing speed or memory impairment in patients with remitted MDD. CONCLUSION: Processing speed is an important factor regarding learning and memory impairment in patients with current MDD. Thereby, our results highlight novel targets for treatment of diminished learning and memory performance via enhancement of processing speed using pharmacological as well as therapeutic interventions.

The causal role of prefrontal hemispheric asymmetry in valence processing of words - Insights from a combined cTBS-MEG study.

Hemispheric asymmetries play an important role in multiple cerebral functions. Asymmetries in prefrontal cortex (PFC) function have been suggested to regulate emotional processing in that right-hemispheric dominance biases towards negative affect, whereas left PFC dominance favors positive affect. This study used transcranial magnetic stimulation to test the causal role of prefrontal asymmetries in the processing of emotional stimuli. To experimentally induce hemispheric asymmetries, 21 healthy volunteers underwent two separate sessions of inhibitory continuous theta burst stimulation (cTBS) to the left versus right dorsolateral prefrontal cortex. Each stimulation was followed by magnetoencephalographic (MEG) recordings of event-related fields elicited by visually presented emotional words in a silent reading task and a subsequent behavioral emotion categorization task. The asymmetry manipulation influenced valence processing of words in early, mid-latency and late time intervals in right occipitotemporal and parietal brain regions. Left-sided cTBS (inducing right-hemispheric dominance) consistently resulted in enhanced brain responses to negative words, while right-sided cTBS (inducing left-hemispheric dominance) enhanced responses to positive words. On a behavioral level, right-hemispheric dominance resulted in more categorization matches of negative compared to positive words, while left-hemispheric dominance resulted in reverse effects. These results provide direct evidence that bottom-up valence processing is influenced by prefrontal hemispheric asymmetry.

Age-related effects in compound production: Evidence from a double-object picture naming task.

This study investigated effects of healthy ageing and of non-verbal attentional control on speech production. Young and older speakers participated in a picture-word interference (PWI) task with compound targets. To increase the processing load, the two pictures of the compounds' constituents were presented side-by-side for spoken naming (e.g., a picture of a sun + a picture of a flower to be named with sunflower). Written distractors either corresponded to the first or second constituent (sun or flower → sunflower), or were semantically related either to the first constituent of the target (moon → sunflower) or to the second constituent/whole word (tulip → sunflower). Morpho-phonological facilitation was obtained for both constituents, whereas semantic interference was restricted to first-constituent-related semantic distractors. Furthermore, a trend towards facilitation was obtained for distractors that were semantically related to the whole word. Older speakers were slower and produced more errors than young speakers. While morphological effects of first-constituent distractors were stronger for the elderly, the semantic effects were not affected by age. Non-verbal attentional control processes, measured in the Simon task, significantly contributed to morpho-phonological priming in the elderly, but they did not affect semantic interference or semantic facilitation. With a picture naming task that increases the semantic and lexical processing load, we corroborate earlier evidence that word-finding difficulties in the elderly result from deficient phonological encoding, whereas lexical-semantic and morpho-phonological representations remain stable with age.

Age-related effects in compound production: Intact lexical representations but more effortful encoding.

The production of nominal compounds in the presence of morphological, semantic, and unrelated distractor words (picture-word interference paradigm) was investigated in young (M = 27 years) and older (M = 70.5 years) German speakers to test models of speech production and lexical representation. Constituent distractors of compound targets (lip or stick for the target LIPSTICK) speeded compound naming, while naming was slowed by distractors that were categorically related to the compound as a whole (powder → LIPSTICK). Furthermore, no effects were obtained for distractors from the same category as the first constituent of compound targets in picture-naming latencies (toe → LIPSTICK). These effects were present in both age groups and indicate that compounds are stored holistically at the lemma level, and as morphemes at the word-form level, unaffected by age. Main effects of age revealed overall slower picture naming and less accurate responses in the elderly. Furthermore, older speakers showed stronger morphological facilitation, while semantic distractor effects were unaffected by age. In a non-verbal attentional control task (Simon task), older speakers were slower overall and showed larger processing costs than young speakers in the conflict (incongruent) condition. Our data replicate a decline in non-verbal attentional control with age and also reveal slower and more error-prone picture-naming in the elderly. These language-specific changes, however, seem to be independent from attentional control and are likely to result from less fluent morpho-phonological encoding in the elderly.

Dissociating predictability, plausibility and possibility of sentence continuations in reading: evidence from late-positivity ERPs.

Late positive event-related potential (ERP) components occurring after the N400, traditionally linked to reanalysis due to syntactic incongruence, are increasingly considered to also reflect reanalysis and repair due to semantic difficulty. Semantic problems can have different origins, such as a mismatch of specific predictions based on the context, low plausibility, or even semantic impossibility of a word in the given context. DeLong, Quante & Kutas (2014) provided the first direct evidence for topographically different late positivities for prediction mismatch (left frontal late positivity for plausible but unexpected words) and plausibility violation (posterior-parietal late positivity for implausible, incongruent words). The aim of the current study is twofold: (1) to replicate this dissociation of ERP effects for plausibility violations and prediction mismatch in a different language, and (2) to test an additional contrast within implausible words, comparing impossible and possible sentence continuations. Our results replicate DeLong, Quante & Kutas (2014) with different materials in a different language, showing graded effects for predictability and plausibility at the level of the N400, a dissociation of plausible and implausible, anomalous continuations in posterior late positivities and an effect of prediction mismatch on late positivities at left-frontal sites. In addition, we found some evidence for a dissociation, at these left-frontal sites, between implausible words that were fully incompatible with the preceding discourse and those for which an interpretation is possible.

Early brain responses to affective faces: A simultaneous EEG-fMRI study.

The spatio-temporal neural basis of earliest differentiation between emotional and neutral facial expressions is a matter of debate. The present study used concurrent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) in order to investigate the 'when' and 'where' of earliest prioritization of emotional over neutral expressions. We measured event-related potentials (ERPs) and blood oxygen dependent (BOLD) signal changes in response to facial expressions of varying emotional intensity and different valence categories. Facial expressions were presented superimposed by two horizontal bars and participants engaged in a focal bars task (low load, high load), in order to manipulate the availability of attentional resources during face perception. EEG data revealed the earliest expression effects in the P1 range (76-128 ms) as a parametric function of stimulus arousal independent of load conditions. Conventional fMRI data analysis also demonstrated significant modulations as a function of stimulus arousal, independent of load, in amygdala, superior temporal sulcus, fusiform gyrus and lateral occipital cortex. Correspondingly, EEG-informed fMRI analysis revealed a significant positive correlation between single-trial P1 amplitudes and BOLD responses in amygdala and lateral posterior occipital cortex. Our results are in line with the hypothesis of the amygdala as fast responding relevance detector and corresponding effects in early visual face processing areas across facial expressions and load conditions.

Seeing for speaking: Semantic and lexical information provided by briefly presented, naturalistic action scenes.

At the interface between scene perception and speech production, we investigated how rapidly action scenes can activate semantic and lexical information. Experiment 1 examined how complex action-scene primes, presented for 150 ms, 100 ms, or 50 ms and subsequently masked, influenced the speed with which immediately following action-picture targets are named. Prime and target actions were either identical, showed the same action with different actors and environments, or were unrelated. Relative to unrelated primes, identical and same-action primes facilitated naming the target action, even when presented for 50 ms. In Experiment 2, neutral primes assessed the direction of effects. Identical and same-action scenes induced facilitation but unrelated actions induced interference. In Experiment 3, written verbs were used as targets for naming, preceded by action primes. When target verbs denoted the prime action, clear facilitation was obtained. In contrast, interference was observed when target verbs were phonologically similar, but otherwise unrelated, to the names of prime actions. This is clear evidence for word-form activation by masked action scenes. Masked action pictures thus provide conceptual information that is detailed enough to facilitate apprehension and naming of immediately following scenes. Masked actions even activate their word-form information-as is evident when targets are words. We thus show how language production can be primed with briefly flashed masked action scenes, in answer to long-standing questions in scene processing.

The relationship between social cognition and executive function in Major Depressive Disorder in high-functioning adolescents and young adults.

To understand how cognitive dysfunction contributes to social cognitive deficits in depression, we investigated the relationship between executive function and social cognitive performance in adolescents and young adults during current and remitted depression, compared to healthy controls. Social cognition and executive function were measured in 179 students (61 healthy controls and 118 patients with depression; Mage = 20.60 years; SDage = 3.82 years). Hierarchical regression models were employed within each group (healthy controls, remitted depression, current depression) to examine the nature of associations between cognitive measures. Social cognitive and executive function did not significantly differ overall between depressed patients and healthy controls. There was no association between executive function and social cognitive function in healthy controls or in remitted patients. However, in patients with a current state of depression, lower cognitive flexibility was associated with lower performance in facial-affect recognition, theory-of-mind tasks and overall affect recognition. In this group, better planning abilities were associated with decreased performance in facial affect recognition and overall social cognitive performance. While we infer that less cognitive flexibility might lead to a more rigid interpretation of ambiguous social stimuli, we interpret the counterintuitive negative correlation of planning ability and social cognition as a compensatory mechanism.

Association of Brain Cortical Changes With Relapse in Patients With Major Depressive Disorder.

Importance: More than half of all patients with major depressive disorder (MDD) experience a relapse within 2 years after recovery. It is unclear how relapse affects brain morphologic features during the course of MDD. Objective: To use structural magnetic resonance imaging to identify morphologic brain changes associated with relapse in MDD. Design, Setting, and Participants: In this longitudinal case-control study, patients with acute MDD at baseline and healthy controls were recruited from the University of Münster Department of Psychiatry from March 21, 2010, to November 14, 2014, and were reassessed from November 11, 2012, to October 28, 2016. Depending on patients' course of illness during follow-up, they were subdivided into groups of patients with and without relapse. Whole-brain gray matter volume and cortical thickness of the anterior cingulate cortex, orbitofrontal cortex, middle frontal gyrus, and insula were assessed via 3-T magnetic resonance imaging at baseline and 2 years later. Main Outcomes and Measures: Gray matter was analyzed via group (no relapse, relapse, and healthy controls) by time (baseline and follow-up) analysis of covariance, controlling for age and total intracranial volume. Confounding factors of medication and depression severity were assessed. Results: This study included 37 patients with MDD and a relapse (19 women and 18 men; mean [SD] age, 37.0 [12.7] years), 23 patients with MDD and without relapse (13 women and 10 men; mean [SD] age, 32.5 [10.5] years), and 54 age- and sex-matched healthy controls (24 women and 30 men; mean [SD] age, 37.5 [8.7] years). A significant group-by-time interaction controlling for age and total intracranial volume revealed that patients with relapse showed a significant decline of insular volume (difference, -0.032; 95% CI, -0.063 to -0.002; P = .04) and dorsolateral prefrontal volume (difference, -0.079; 95% CI, -0.113 to -0.045; P < .001) from baseline to follow-up. In patients without relapse, gray matter volume in these regions did not change significantly (insula: difference, 0.027; 95% CI, -0.012 to 0.066; P = .17; and dorsolateral prefrontal volume: difference, 0.023; 95% CI, -0.020 to 0.066; P = .30). Volume changes were not correlated with psychiatric medication or with severity of depression at follow-up. Additional analysis of cortical thickness showed an increase in the anterior cingulate cortex (difference, 0.073 mm; 95% CI, 0.023-0.123 mm; P = .005) and orbitofrontal cortex (difference, 0.089 mm; 95% CI, 0.032-0.147 mm; P = .003) from baseline to follow-up in patients without relapse. Conclusion and Relevance: A distinct association of relapse in MDD with brain morphologic features was revealed using a longitudinal design. Relapse is associated with brain structures that are crucial for regulation of emotions and thus needs to be prevented. This study might be a step to guide future prognosis and maintenance treatment in patients with recurrent MDD.

tDCS over the motor cortex improves lexical retrieval of action words in poststroke aphasia.

One-third of stroke survivors worldwide suffer from aphasia. Speech and language therapy (SLT) is considered effective in treating aphasia, but because of time constraints, improvements are often limited. Noninvasive brain stimulation is a promising adjuvant strategy to facilitate SLT. However, stroke might render "classical" language regions ineffective as stimulation sites. Recent work showed the effectiveness of motor cortex stimulation together with intensive naming therapy to improve outcomes in aphasia (Meinzer et al. 2016). Although that study highlights the involvement of the motor cortex, the functional aspects by which it influences language remain unclear. In the present study, we focus on the role of motor cortex in language, investigating its functional involvement in access to specific lexico-semantic (object vs. action relatedness) information in poststroke aphasia. To this end, we tested effects of anodal transcranial direct current stimulation (tDCS) to the left motor cortex on lexical retrieval in 16 patients with poststroke aphasia in a sham-controlled, double-blind study design. Critical stimuli were action and object words, and pseudowords. Participants performed a lexical decision task, deciding whether stimuli were words or pseudowords. Anodal tDCS improved accuracy in lexical decision, especially for words with action-related content and for pseudowords with an "action-like" ending ( t15 = 2.65, P = 0.036), but not for words with object-related content and pseudowords with "object-like" characteristics. We show as a proof-of-principle that the motor cortex may play a specific role in access to lexico-semantic content. Thus motor-cortex stimulation may strengthen content-specific word-to-semantic concept associations during language treatment in poststroke aphasia. NEW & NOTEWORTHY The role of motor cortex (MC) in language processing has been debated in both health and disease. Recent work has suggested that MC stimulation together with speech and language therapy enhances outcomes in aphasia. We show that MC stimulation has a differential effect on object- and action-word processing in poststroke aphasia. We propose that MC stimulation may specifically strengthen word-to-semantic concept association in aphasia. Our results potentially provide a way to tailor therapies for language rehabilitation.

Cardiorespiratory concerns shape brain responses during automatic panic-related scene processing in patients with panic disorder.

BACKGROUND: Increased automatic processing of threat-related stimuli has been proposed as a key element in panic disorder. Little is known about the neural basis of automatic processing, in particular to task-irrelevant, panic-related, ecologically valid stimuli, or about the association between brain activation and symptomatology in patients with panic disorder. METHODS: The present event-related functional MRI (fMRI) study compared brain responses to task-irrelevant, panic-related and neutral visual stimuli in medication-free patients with panic disorder and healthy controls. Panic-related and neutral scenes were presented while participants performed a spatially nonoverlapping bar orientation task. Correlation analyses investigated the association between brain responses and panic-related aspects of symptomatology, measured using the Anxiety Sensitivity Index (ASI). RESULTS: We included 26 patients with panic disorder and 26 heatlhy controls in our analysis. Compared with controls, patients with panic disorder showed elevated activation in the amygdala, brainstem, thalamus, insula, anterior cingulate cortex and midcingulate cortex in response to panic-related versus neutral task-irrelevant stimuli. Furthermore, fear of cardiovascular symptoms (a subcomponent of the ASI) was associated with insula activation, whereas fear of respiratory symptoms was associated with brainstem hyperactivation in patients with panic disorder. LIMITATIONS: The additional implementation of measures of autonomic activation, such as pupil diameter, heart rate, or electrodermal activity, would have been informative during the fMRI scan as well as during the rating procedure. CONCLUSION: Results reveal a neural network involved in the processing of panic-related distractor stimuli in patients with panic disorder and suggest an automatic weighting of panic-related information depending on the magnitude of cardiovascular and respiratory symptoms. Insula and brainstem activations show function-related associations with specific components of panic symptomatology.