The insula is deeply connected to the amygdala, and both regions display activation in response to processing negative emotional stimuli. Hyperactivity in the insula has been found in individuals with SAD, specific phobias, and PTSD.

When individuals with SAD were tasked with giving an impromptu speech about a randomly generated topic, they demonstrated an increased activation in the right insula compared to healthy controls. This hyperactivity was correlated with self-reported increases in unpleasantness, arousal, and anxiety following the anticipation of giving the speech.