Between Action and Emotional Survival During the COVID-19 era: Sensorimotor Pathways as Control Systems of Transdiagnostic Anxiety-Related Intolerance to Uncertainty

Sari Goldstein Ferber, Gal Shoval, Gil Zalsman, Mario Mikulincer, Aron Weller

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives: The COVID-19 pandemic and aligned social and physical distancing regulations increase the sense of uncertainty, intensifying the risk for psychopathology globally. Anxiety disorders are associated with intolerance to uncertainty. In this review we describe brain circuits and sensorimotor pathways involved in human reactions to uncertainty. We present the healthy mode of coping with uncertainty and discuss deviations from this mode. Methods: Literature search of PubMed and Google Scholar. Results: As manifestation of anxiety disorders includes peripheral reactions and negative cognitions, we suggest an integrative model of threat cognitions modulated by sensorimotor regions: “The Sensorimotor-Cognitive-Integration-Circuit.” The model emphasizes autonomic nervous system coupling with the cortex, addressing peripheral anxious reactions to uncertainty, pathways connecting cortical regions and cost-reward evaluation circuits to sensorimotor regions, filtered by the amygdala and basal ganglia. Of special interest are the ascending and descending tracts for sensory-motor crosstalk in healthy and pathological conditions. We include arguments regarding uncertainty in anxiety reactions to the pandemic and derive from our model treatment suggestions which are supported by scientific evidence. Our model is based on systematic control theories and emphasizes the role of goal conflict regulation in health and pathology. We also address anxiety reactions as a spectrum ranging from healthy to pathological coping with uncertainty, and present this spectrum as a transdiagnostic entity in accordance with recent claims and models. Conclusions: The human need for controllability and predictability suggests that anxiety disorders reactive to the pandemic's uncertainties reflect pathological disorganization of top-down bottom-up signaling and neural noise resulting from non-pathological human needs for coherence in life.

Original languageEnglish
Article number680403
JournalFrontiers in Psychiatry
StatePublished - 29 Jul 2021

Bibliographical note

Funding Information:
The authors thank Prof. Haim Belmaker for his careful review and contribution to this manuscript.

Publisher Copyright:
© Copyright © 2021 Goldstein Ferber, Shoval, Zalsman, Mikulincer and Weller.


  • ANS
  • COVID-19
  • anxiety disorders
  • ascending activating system
  • control theory
  • descending activation
  • sensorimotor


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