Solving the prefrontal conundrum of high-order anxiety: conciliating HOTEC and hypofrontality. A theoretical review.

INTRODUCTION: According to the High-order Theory of Emotional Consciousness (HOTEC), every emotional process is a conscious and high-order state of mind carried out by the General Networks of Cognition (GNC), which consists mainly of prefrontal mechanisms. This means that anxiety is also an emotional state of mind carried out by the GNC (positive correlation). However, numerous studies have suggested what is commonly called "hypofrontality" during states of anxiety (negative correlation), which seems to give rise to a theoretical and empirical contraction.

METHODS: I present a theoretical review to address the following issue: how to advocate a HOTEC view of anxiety in the face of a growing paradigm of hypofrontality during states of anxiety?

RESULTS: Here I propose that dmPFC, the dACC, and the anterior insula are GNC areas positively correlated with anxiety, which, along with the prefrontal areas responsible for regulating the activation of survival circuits and driving the attention to adaptive ways to overcome potential threats, form an interconnective model of anticipatory and regulatory mechanisms related to learned threats based on autobiographical memories.

CONCLUSIONS: Through this model, I propose that HOTEC is still a valid way to approach and understand both healthy and unhealthy anxious states of mind.