Brain lesions that damage the insular cortex interrupt addictive behaviors, suggesting that drug addiction sensitizes the insula. However, neuroimaging studies seem to lead to an opposite picture: structural neuroimaging studies show reduced grey matter volume of the insular cortex (IC) of drug users, and functional neuroimaging studies show reduced IC activity when drug users perform decision-making tasks. These results have been interpreted as indicating that addictive behaviors are associated with reduced interoceptive signaling within the IC. We use this apparent contradiction to examine possible roles of the insula in addiction, identify open questions, and explore ways to address them.

This paper presents a coherent account of the role of the insular cortex (IC) in decision-making. We follow a conceptualization of decision-making that is very close to one previously proposed by Ernst and Paulus (2005): that the decision process is a progression of four phases: (1) re-focusing attention; (2) evaluation; (3) action; and (4) outcome processing, and we present evidence for the insula’s role in all these phases. We review the existing work on insula’s functional anatomy that subdivides the IC into posterior, dorsal anterior and ventral anterior regions. We re-map the results provided by the existing literature into these subdivisions wherever possible, to identify the components’ role in each decision making phase. In addition, we identify a self-regulating quality of the IC focused on harm avoidance.

Mindfulness-based curricula are being implemented in K-12 schools across the nation. Many of these programs, although well-considered and implemented, have little or no research support for their effectiveness. Recognizing the paucity of published research in this area, a sampling of school-based programs currently being implemented in the schools is reviewed. The programs reviewed are Inner Explorer, Master Mind and Moment Program, Mindfulness and Mind-Body Skills for Children, Mindful Schools, Resilient Kids, Still Quiet Place, Stress Reduction and Mindfulness Curriculum and Mindful Moment, and Wellness and Resilience Program. We offer a summary of research support for each program and discussion of unpublished, mostly qualitative indicators of feasibility, acceptability, efficacy, and effectiveness. Strengths and limitations of each program are described, along with suggestions for bolstering informative and useful research. We encourage researchers, educators, and mindfulness practitioners to work collaboratively to conduct rigorous program evaluations.

Impairments in flexible goal-directed decisions, often examined by reversal learning, are associated with behavioral abnormalities characterized by impulsiveness and disinhibition. Although the lateral orbital frontal cortex (OFC) has been consistently implicated in reversal learning, it is still unclear whether this region is involved in negative feedback processing, behavioral control, or both, and whether reward and punishment might have different effects on lateral OFC involvement. Using a relatively large sample (N = 47), and a categorical learning task with either monetary reward or moderate electric shock as feedback, we found overlapping activations in the right lateral OFC (and adjacent insula) for reward and punishment reversal learning when comparing correct reversal trials with correct acquisition trials, whereas we found overlapping activations in the right dorsolateral prefrontal cortex (DLPFC) when negative feedback signaled contingency change. The right lateral OFC and DLPFC also showed greater sensitivity to punishment than did their left homologues, indicating an asymmetry in how punishment is processed. We propose that the right lateral OFC and anterior insula are important for transforming affective feedback to behavioral adjustment, whereas the right DLPFC is involved in higher level attention control. These results provide insight into the neural mechanisms of reversal learning and behavioral flexibility, which can be leveraged to understand risky behaviors among vulnerable populations.