COGNITIVE NEUROSCIENCE AND NEUROPSYCHOLOGYAltered insula activation in anticipation of changing emotional states neural mechanisms underlying cognitive flexibility in special operations forces personnelSimmons, Alan N.a,b; Fitzpatrick, Summerb,f; Strigo, Irina A.a,b; Potterat, Eric G.c,d; Johnson, Douglas C.b,c,e; Matthews, Scott C.a,b; Van Orden, Karl F.c,e; Swain, Judith L.b,c,g; Paulus, Martin P.a,b,cAuthor Information aVeterans Affairs San Diego Healthcare System bUniversity of California San Diego cOptiBrain Consortium dNaval Special Warfare Group One eNaval Health Research Center, La Jolla, San Diego, California fUniversity of Texas at Austin, Texas, USA gSingapore Institute for Clinical Sciences-A*STAR and National University of Singapore, Singapore Correspondence to Alan N. Simmons, PhD, Department of Psychiatry, University of California San Diego (Mailcode 0151B), 9500 Gilman Dr, La Jolla, San Diego, CA 92093, USA Tel: + 858 642 3547; fax: + 858 534 4950; e-mail: [email protected] Received December 5, 2011 Accepted December 7, 2011 NeuroReport: March 7, 2012 - Volume 23 - Issue 4 - p 234-239 doi: 10.1097/WNR.0b013e3283503275 Buy Metrics Abstract Individuals who perform optimally in extreme conditions, such as elite military warriors, can provide valuable insight into the neurobehavioral mechanisms underlying extraordinary performance. In the current study, we examined the degree to which Navy SEALs, when compared with healthy volunteers, could show more right anterior insula activation when shifting from anticipating one emotion to another during functional MRI. Consistent with our hypothesis, SEALs showed attenuated insula activation to negative image relative to positive image anticipation and greater right anterior insula activation during affective set-shifting. These findings suggest that elite warriors show combined (a) minimal reactivity during negative stimuli and (b) an enhanced ability to efficiently change their physiological state. These neural changes may underlie their ability to perform well in stressful situations. © 2012 Lippincott Williams & Wilkins, Inc.