DLPFC and Sympathetic Reactivity in RPL With Anxiety

To elicit hemodynamic responses in the dorsolateral prefrontal cortex (DLPFC) and activate the sympathetic nervous system, we used a standardized multisensory aversive stimulation protocol comprising: (i) Visual stimuli: 72 high-arousal images from the GAPED database (moral violations, legal violations, fear-related) shown in 12 blocks (6 images/block, 5 s each) with 20 s baseline and 30 s stimulation; (ii) Auditory stimuli: each block paired with 30 s of calibrated 90 dB(A) high-frequency narrowband white noise (4 kHz center frequency), shown to increase heart rate; (iii) Cold-pain stimuli: during each block, participants placed both hands on 0 °C ice-filled bottles for pain-induced sympathetic activation. This tri-modal task reliably provokes DLPFC engagement and autonomic responses.