This functional magnetic resonance imaging (fMRI) study directly compared the neurocircuitry involved in three different attentional strategies during affective picture processing. We exposed 40 participants (20 men, 20 women) to images depicting dental treatment, as well as neutral scenes. They were asked to do one of three tasks while watching the same pictures: directing their attention toward a foreground object within the picture (distraction), classifying whether the image showed dental treatment, or deciding whether the scene elicited fear of pain (introspection). The participants performed the distraction and classification task with high accuracy and rated only 11 of the dental treatment pictures as pain relevant. Introspection was associated with increased activation of the dorsomedial prefrontal cortex (DMPFC), relative to the two other conditions. Since the dental, relative to the neutral, pictures elicited enhanced DMPFC activation across all conditions, this underlines the role of this brain region for the assignment, as well as self-reference, of affective meaning. Moreover, self-reported dental anxiety was positively correlated with activation of a pain modulatory network (DMPFC, basal ganglia) when the participants focused on the pain relevance of the dental treatment cues. For future studies, it seems promising to study a high-anxious group or even patients afflicted with dental phobia.
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