Insular-striatal activation during COVID-19 predicts stress reactivity in high-trait anxiety

The COVID-19 pandemic, unlike natural disasters that cause short-term stress, has led to prolonged psychological strain, increasing attentional biases toward health threats and worsening mental health. Prolonged exposure to pandemic-related stressors has exacerbated these issues, with individual differences, such as anxiety levels, influencing vulnerability and resulting in varied outcomes. Understanding how neurocognitive processes modulate attentional biases, such as prolonged attention (overresponding) to threats or avoidance, is crucial for explaining their effects on mental health during the pandemic. Real-world examination of these biases is needed to confirm their manifestation and better target interventions. This longitudinal study explored the neural network of attentional biases in anxious individuals, focusing on whether initial activation at baseline (T1) could predict changes in perceived stress. High and low trait anxious (HTA, LTA) adults completed an emotional Stroop task during two fMRI visits, one year apart. Results showed insular-fronto-striatal hypoactivation in the HTA group over time, indicating increased avoidance in HTA participants. Initial insular-striatal activation at T1 predicted perceived stress changes in the HTA group. Reduced activation in these regions suggests avoidance and impaired stress coping, highlighting increased stress vulnerability in HTA individuals during the pandemic and underscoring the importance of interventions to enhance resilience.