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Insular cortex

Dr. Simon Moss


The insular cortex is a brain region, located between the temporal lobe and parietal lobe, buried within the lateral sulcus. Overall, the insular cortex, sometimes called the insula, is integral to the experience of emotions, the processing of tastes, the memory of procedures, and the control of motor responses as well as interpersonal behavior. Negative emotions in particular, such as disgust (Wicker, Keysers, Plailly, Royet, Gallese, & Rizzolatti, 2003& Wright, He, Shapira, Goodman, & Liu, 2004), seem to activate this region.

Functions of the insular cortex

Risky decision making

The insular cortex seems to be intimately involved in decision making, especially when the outcomes are uncertain (e.g., Preuschoff, Quartz, & Bossaerts, 2008). That is, individuals often need to decide which of several alternatives to pursue. Occasionally, some of these options could potentially elicit a host of aversive outcomes. When individuals anticipate the possibility of potential adversities, the insular cortex seems to become especially activated (e.g., Critchley, Mathias, & Dolan, 2001& Smith, Mitchell, Hardin, Jazbec, Fridberg, Blair, & Ernst, 2009). Indeed, anticipation of negative stimuli is regarded as one of the key functions of the insular cortex (e.g., Seymour, Singer, & Dolan, 2007).

Perhaps because of this anticipation of negative events, activation of the insula is correlated with risk aversion (e.g., Kuhnen & Knutzon, 2005& Paulus, Rogalsky, Simmons, Feinstein, & Stein, 2003). Indeed, after lesions of the insular cortex, individuals prefer more risky options in gambling tasks--that is, options in which the outcomes are less certain (Clark, Bechara, Damasio, Aitken, Sahakian, & Robbins, 2008). Presumably, when this region is activated, individuals become more sensitive to adverse possibilities, sometimes called a sensitivity to punishment. Risky alternatives, in which adversities are possible, thus seem less appealing.

Moral decision making

The insular cortex also seems to be involved in moral decision making. That is, in many instances, individuals need to decide between two alternatives. One alternative will increase equity. The other alternative will reduce equity but increase the aggregate resources. To illustrate, governments might need to decide whether to fund all schools, which improves equality, or only the schools that perform well, which can encourage performance on average but undermine equality.

As fMRI studies highlight, when activity in the insular cortex is elevated, individuals subsequently prefer the more equitable option (Hsu, Anen, & Quartz, 2008). Thus, the insular cortex seems to inhibit inequitable as well as risky decisions.

The Ultimate Game task has often been administered to assess these preferences towards the equitable distribution of resources. Typically, participants interact with another person who has been bestowed a sum of money. This person is then instructed to share a small amount of this money with participants. If participants reject the offer, neither they nor this person receive any of the money--but the outcome is equitable. If participants accept the offer, the other person does retain most of the money and, hence, the outcome is not equitable.

As Sanfey, Rilling, Aronson, Nystrom, and Cohen (2003) showed the insular cortex becomes activated in the aftermath of unfair responses. Hence, the insular seems to represent inequity. Furthermore, this activation often translates to rejection of the offer.

Anxiety and neuroticism

Some researchers maintain that elevated levels of insular activation might vary consistently across individuals. That is, activation might be especially elevated in some individuals, across a range of settings. This elevated activation of the insula might coincide with neuroticism and anxiety disorders (Paulus & Stein, 2006). This premise is consistent with the findings that insular activation is associated with sensitivity to punishment and adversity.

To demonstrate, in a study conducted by Stein, Simmons, Feinstein, and Paulhus (2007), a series of positive, neutral, and negative facial expressions were presented. Interestingly, in patients who report elevated levels of anxiety and neuroticism, both the amygdala and insular were especially sensitive to the emotional expressions. Similarly, Wright, Martin, McMullin, Sin, and Rauch (2003) showed that insula activity is elevated in individuals with phobias of small animals.

Furthermore, drugs that alleviate anxiety have been shown to suppress insula activity, as reviewed by Paulus and Stein (2006). An example is lorazepam, a benzodiazepine drug, which can curb panic and other forms of anxiety, but also reduces insula activity (Paulus, Feinstein, Castillo, Simmons, & Stein, 2005). This finding also aligns to the proposition that many anxiety disorders might coincide with elevated activation of the insula.

Bodily awareness

The insular cortex seems to be involved in awareness of bodily states (see Craig, 2009& see also Karnath, Baier, & Nagele, 2005), and this awareness also modulates physiological responses. For example, the insular seems to be involved in the awareness and sensation of pain (see Baliki, Geha, & Apkarian, 2009). Even imagining pain in the body activates the insula (Ogino, Nemoto, Inui, Saito, Kakigi, & Goto, 2007).

In addition to pain, many other bodily sensations activate the insula, such as warmth (Olausson, Charron, Marchand, Villemure, Strigo, Bushnell, 2005) and stomach distension (Ladabaum, Minoshima, Hasler, Cross, Chey, Owyang, 2001). These responses to bodily sensations can then affect physiological processes, such as regulation of blood pressure, especially during exercise and exertion (see Williamson, McColl, Mathews, Ginsburg, & Mitchell, 1999).

Motor control

In addition to representing bodily sensations, the insular cortex is also involved in motor control, such as eye movement, swallowing, the cardiac system (Williamson, McColl, Mathews, Ginsburg, & Mitchell, 1999), and speech (Dronkers, 1996). For example, the insular cortex is vital to facilitate the articulation of long, complex sentences (Borovsky, Saygin, Bates, Dronkers, 2007).


In the figure below, AIC and PIC represent the anterior and posterior insular cortices respectively. That is, the insular cortex comprises two main sections: the anterior and posterior regions. The anterior insula is larger than is the posterior insula.

insular cortex

Most of the input to the anterior insular is derived from the basal part of the ventral medial nucleus in the thalamus and the central nucleus of the amygdala. Furthermore, the anterior insular also projects back to the amygdalas.

The posterio insular, in contrast, is connected to areas in the primary and secondary sensory cortices. This region also receives input from the ventral posterior inferior in the thalamus via the spine.


Ackermann, H. & Riecker, A. (2004). The contribution of the insula to motor aspects of speech production: A review and a hypothesis. Brain Language, 89, 320-328.

Anderson, T. J., Jenkins, I. H., Brooks, D. J., Hawken, M. B., Frackowiak, R. S., & Kennard, C. (1994). Cortical control of saccades and fixation in man. A PET study. Brain, 117, 1073-1084.

Baliki, M. N., Geha, P. Y., & Apkarian, A. V. (2009). Parsing pain perception between nociceptive representation and magnitude estimation. Journal of Neurophysiology, 101, 875-887.

Borovsky, A., Saygin, A. P., Bates, E., Dronkers, N. (2007). Lesion correlates of conversational speech production deficits. Neuropsychologia, 45, 2525-2233.

Brown, S., Martinez, M. J., & Parsons, L. M. (2004). Passive music listening spontaneously engages limbic and paralimbic systems. Neuroreport, 15, 2033-2037.

Clark, L., Bechara, A., Damasio, H., Aitken, M. R. F., Sahakian, B. J., & Robbins, T. W. (2008). Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making. Brain, 131, 1311-1322.

Craig, A. D. (2009). How do you feel--now? The anterior insula and human awareness. Nature Reviews: Neuroscience, 10, 59-70.

Craig, A. D., Chen, K., Bandy, D., Reiman, E. M., (2000). Thermosensory activation of insular cortex. Nature Neuroscience, 3, 184-190.

Critchley, H. D., Mathias C. J., & Dolan, R. J. (2001). Neural activity in the human brain relating to uncertainty and arousal during anticipation. Neuron, 29, 537-545.

Critchley, H. D., Wiens, S., Rotshtein, P., Ohman, A., Dolan, R. J. (2004). Neural systems supporting interoceptive awareness. Nature Neuroscience, 7, 189-95.

Dronkers N. F. (1996). A new brain region for coordinating speech articulation. Nature, 384, 159-161.

Ernst, M., & Paulus, M. P., (2005). Neurobiology of decision making: a selective reviewfrom a neurocognitive and clinical perspective. Biological Psychiatry, 58, 597-604.

Ernst, M., Bolla, K., Mouratidis, M., Contoreggi, C., Matochik, J.A., Kurian, V.S., et al., (2002). Decision-making in a risk-taking task: a PET study. Neuropsychopharmacology 26, 682-691.

Hsu, M., Anen, C., & Quartz, S. R. (2008). The right and the good: Distributive justice and neural encoding of equity and efficiency. Science, 320, 1092-1095.

Karnath, H. O., Baier, B. & Nagele, T. (2005). Awareness of the functioning of one's own limbs mediated by the insular cortex? Journal of Neuroscience, 25, 7134-7138.

Kuhnen, C. M., & Knutzon, B, (2005). The neural basis of financial risk taking. Neuron, 47, 763-770.

Ladabaum, U., Minoshima, S., Hasler, W. L., Cross, D., Chey, W. D., Owyang, C. (2001). Gastric distention correlates with activation of multiple cortical and subcortical regions. Gastroenterology, 120, 369-376.

Ogino, Y., Nemoto, H., Inui, K., Saito, S., Kakigi, R., & Goto, F. (2007). Inner experience of pain: Imagination of pain while viewing images showing painful events forms subjective pain representation in human brain. Cerebral Cortex, 17, 1139-1146.

Olausson, H., Charron, J., Marchand, S., Villemure, C., Strigo, I. A., Bushnell, M. C. (2005). Feelings of warmth correlate with neural activity in right anterior insular cortex. Neuroscience Letters 25, 389, 1-5.

Oppenheimer, S. M., Gelb, A., Girvin, J. P., & Hachinski, V. C. (1992). Cardiovascular effects of human insular cortex stimulation. Neurology, 42, 1727-1732.

Ortigue, S., Grafton, S. T. & Bianchi-Demicheli, F. (2007). Correlation between insula activation and self-reported quality of orgasm in women. Neuroimage, 37, 551-560.

Paulus, M. P., (2005). Neurobiology of decision-making: quo vadis? Cognitive Brain Research, 23, 2-10.

Penfield, W. & Faulk, M. E. (1955). The insula. Brain, 78, 445-470.

Preuschoff, K., Quartz, S. R. & Bossaerts, P. (2008). Human insula activation reflects risk prediction errors as well as risk. Journal of Neuroscience, 28, 2745-2752.

Paulus, M. P., Feinstein, J. S., Castillo, G., Simmons, A. N., & Stein, M. B. (2005). Dose-dependent decrease of activation in bilateral amygdale and insula by lorazepam during emotion processing. Archives of General Psychiatry, 62, 282-288.

Paulus, M. P., Rogalsky, C., Simmons, A., Feinstein, J. S., & Stein, M. B., (2003). Increased activation in the right insula during risk-taking decision making is related to harm avoidance and neuroticism. NeuroImage, 19, 1439-1448.

Paulus, M. P. & Stein, M. B. (2006). An insular view of anxiety. Biological Psychiatry, 60, 383-387.

Phan, K. L., Wager, T., Taylor, S. F., & Liberzon, I. (2002). Functional neuroanatomy of emotion: A meta-analysis of emotion activation studies in PET and fMRI. Neuroimage, 16, 331-348.

Phillips, M. L., Young, A. W., Scott, S. K., Calder, A. J., Andrew, C., Giampietro, V. S., et al., (1998). Neural responses to facial and vocal expressions of fear and disgust. Proceedings of the Royal Society: Biological Sciences, 265, 1809-1817.

Phillips, M.L., Williams, L.M., Heining, M., Herba, C.M., Russell, T., Andrew, C., et al., (2004). Differential neural responses to overt and covert presentations of facial expressions of fear and disgust. NeuroImage, 21, 1484-1496.

Preuschoff, K., Quartz, S. R., Bossaerts, P., (2008). Human insula activation reflects risk prediction errors as well as risk. Journal of Neuroscience, 28, 2745-2752.

Ramautar, J. R., Slagter, H. A., Kok, A. & Ridderinkhof, K. R. (2006). Probability effects in the stop-signal paradigm: The insula and the significance of failed inhibition. Brain Research, 1105, 143-154.

Rolls, E. T., McCabe, C., Redoute, J., (2008). Expected value, reward outcome, and temporal difference error representations in a probabilistic decision task. Cerebral Cortex, 18, 652-663.

Sanfey, A. G., Rilling, J. K., Aronson, J. A., Nystrom, L. E., & Cohen, J. D. (2003). The neural basis of economic decision-making in the Ultimate Game. Science, 300, 1755-1758.

Seymour, B., Singer, T., & Dolan, R. (2007). The neurobiology of punishment. Nature Reviews Neuroscience, 8, 300-311.

Small, D. M., Zatorre, R. J., Dagher, A., Evans, A. C. & Jones-Gotman, M. (2001). Changes in brain activity related to eating chocolate: from pleasure to aversion. Brain, 124, 1720-1733.

Smith, B. W., Mitchell, D. G. V., Hardin, M. G., Jazbec, S., Fridberg, D., Blair, R. J. R., & Ernst, M. (2009). Neural substrates of reward magnitude, probability, and risk during a wheel of fortune decision-making task. NeuroImage, 44, 600-609.

Stein, M. B., Simmons, A. N., Feinstein, J. S., & Paulhus, M. P. (2007). Increased amygdala and insula activation during emotion processing in anxiety-prone subjects. American Journal of Psychiatry, 164, 318-327.

Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61, 201-216.

Tsakiris, M., Hesse, M. D., Boy, C., Haggard, P., & Fink, G. R. (2007). Neural signatures of body ownership: a sensory network for bodily self-consciousness. Cerebral Cortex, 17, 2235-2244.

Vorel, S. R., Bisaga, A., McKhann, G., & Kleber, H. D. (2007). Insula damage and quitting smoking. Science, 317, 318-319.

Wicker, B., Keysers, C., Plailly, J., Royet, J. P., Gallese, V., & Rizzolatti, G. (2003). Both of us disgusted in My insula: The common neural basis of seeing and feeling disgust, Neuron, 40, 655-656.

Williamson, J. W., McColl, R., Mathews, D., Ginsburg, M., & Mitchell, J. H. (1999). Activation of the insular cortex is affected by the intensity of exercise. Journal of Applied Physiology, 87, 1213-1219.

Wright, P., He, G., Shapira, N. A., Goodman, W. K., & Liu, Y. (2004). Disgust and the insula: fMRI responses to pictures of mutilation and contamination. Neuroreport, 15, 2347-2351.

Wright, P., Martin, B., McMullin, K., Sin, L. M., & Rauch, S. L. (2003). Amygdala and insular responses to emotionally valenced human faces in small animal specific phobia. Biological Psychiatry, 54, 1067-1076.

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