Attention bias modification reduces neural correlates of response monitoring

Multiple Adaptive Attention-Bias-Modification Programs to Alter Normative Increase in the Error-Related Negativity in Adolescents

In the current article, we examined the impact of two home-delivered attentional-bias-modification (ABM) programs on a biomarker of anxiety (i.e., the error-related negativity [ERN]). The ERN is sensitivity to ABM-related changes; however, it is unclear whether ABM exerts its influence on the ERN and anxiety by increasing general attentional control or by disengaging spatial allocation of attention. In this study, we measured the ERN, anxiety, attention bias, and attention control before and after two versions of ABM training and a waitlist control group in 546 adolescents. An ABM designed to increase attention control modulated the ERN but had no impact on anxiety. An ABM designed to reduce attentional bias changed bias and self-reported anxiety in youths but had no impact on the ERN or parent-reported anxiety. These results suggest that the ERN and normative anxiety may be modified using attention training.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

Candidate biomarkers in psychiatric disorders: state of the field

The field of psychiatry is hampered by a lack of robust, reliable and valid biomarkers that can aid in objectively diagnosing patients and providing individualized treatment recommendations. Here we review and critically evaluate the evidence for the most promising biomarkers in the psychiatric neuroscience literature for autism spectrum disorder, schizophrenia, anxiety disorders and post-traumatic stress disorder, major depression and bipolar disorder, and substance use disorders. Candidate biomarkers reviewed include various neuroimaging, genetic, molecular and peripheral assays, for the purposes of determining susceptibility or presence of illness, and predicting treatment response or safety. This review highlights a critical gap in the biomarker validation process. An enormous societal investment over the past 50 years has identified numerous candidate biomarkers. However, to date, the overwhelming majority of these measures have not been proven sufficiently reliable, valid and useful to be adopted clinically. It is time to consider whether strategic investments might break this impasse, focusing on a limited number of promising candidates to advance through a process of definitive testing for a specific indication. Some promising candidates for definitive testing include the N170 signal, an event-related brain potential measured using electroencephalography, for subgroup identification within autism spectrum disorder; striatal resting-state functional magnetic resonance imaging (fMRI) measures, such as the striatal connectivity index (SCI) and the functional striatal abnormalities (FSA) index, for prediction of treatment response in schizophrenia; error-related negativity (ERN), an electrophysiological index, for prediction of first onset of generalized anxiety disorder, and resting-state and structural brain connectomic measures for prediction of treatment response in social anxiety disorder. Alternate forms of classification may be useful for conceptualizing and testing potential biomarkers. Collaborative efforts allowing the inclusion of biosystems beyond genetics and neuroimaging are needed, and online remote acquisition of selected measures in a naturalistic setting using mobile health tools may significantly advance the field. Setting specific benchmarks for well-defined target application, along with development of appropriate funding and partnership mechanisms, would also be crucial. Finally, it should never be forgotten that, for a biomarker to be actionable, it will need to be clinically predictive at the individual level and viable in clinical settings.

The role of attentional shifting in the relation between error monitoring and anxiety in youth

The error-related negativity (ERN), a well-established neural marker of anxiety, reflects enhanced attention to internal threat signals. While attention to threat plays a crucial role in the development and maintenance of anxiety, it is unclear how attentional control influences the ERN-anxiety association. To address this, 37 youths (M_age = 10.89 years) completed self-report measures of attentional control and anxiety symptoms. To obtain ERN amplitude, youth completed a flanker task while simultaneous EEG was collected. Attentional control, specifically attentional shifting rather than focusing, moderated the relation between ERN amplitude and anxiety. Youth who displayed smaller neural responses to making an error and higher ability to shift attention experienced lower levels of anxiety, relative to those who exhibited larger neural responses to making an error or lower attention-shifting ability. These findings highlight that response magnitude to internal threat and ability to flexibly shift attention may jointly contribute to anxiety in youth.

Targeting cognitive control to reduce anxiety in very young children: A proof of concept study

OBJECTIVE

Underdeveloped cognitive control (CC)-the capacity to flexibly adjust to changing environments-may predispose some children to early onset anxiety disorders and represents a promising intervention target. The current study established and pilot-tested "Camp Kidpower"-a novel group-based, interactive CC training intervention-and assessed its impacts on behavioral and neurophysiological indices of CC among preschool children with elevated anxiety symptoms.

METHODS

Forty-four anxious children (4-6 years) were enrolled in Camp Kidpower, delivered in four sessions over 10 days. Before and after camp, children's capacity for CC was measured using well-validated, non-trained behavioral tasks and error-related negativity (ERN). Child anxiety symptoms were measured by parent report on the Spence Preschool Anxiety Scale.

RESULTS

Thirty-two children completed the study, as defined by completion of pre- and follow-up assessments and at least three camp sessions. From baseline to after camp, performance on behavioral tests of CC improved, ERN amplitude increased, and anxiety symptoms decreased.

CONCLUSION

Results provide initial evidence that play-based cognitive training targeted to behavioral and brain markers of CC reduces anxiety in preschoolers.

On the relationship between the error-related negativity and anxiety in children and adolescents: From a neural marker to a novel target for intervention

The current review focuses on our work on the relationship between the error-related negativity (i.e., ERN) and anxiety in children and adolescents. The ERN is an event-related potential (ERP) that appears as a negative deflection in the ERP waveform when individuals make errors and has been found to be increased in anxious individuals. We, and others, have extended this work into developmental populations, finding that the ERN can be measured reliably in children and that the ERN is increased among clinically anxious youth. Furthermore, we have found that the ERN predicts risk for increases in anxiety across development, among healthy and clinically anxious children. We have done work to elucidate what psychological phenomena the increased ERN among anxious children may reflect by creating a self-report measure of error sensitivity (i.e., the Child Error Sensitivity Index) that relates to the ERN. Moreover, we review our work on parenting and the ERN, which suggests that harsh or critical parenting styles may potentiate the ERN in offspring. And, building on these findings, we discuss our recent work to develop novel, computerized intervention strategies to reduce the ERN and thereby risk for anxiety.

The Effect of Safety Signs on the Monitoring of Conflict and Erroneous Response

The safety sign is important in our daily life and workplace to prevent potential safety issues. However, it remains undetermined whether the safety signs would influence the cognitive control ability of the people, which serves to guide the behaviors in a goal-directed manner. Therefore, this study aimed to examine the effect of safety signs on cognitive control by uncovering the behavioral performance and neural manifestations underlying the monitoring of conflict and error. The participants performed a flanker task after watching low- and high-hazard safety signs with the electroencephalogram (EEG) data recorded continually. The behavioral results indicated a classic congruency effect with higher accuracy rate and faster response time under a congruent condition compared to an incongruent condition. However, no hazard effect on behavioral performances was observed. The results of event-related potentials (ERPs) demonstrated a more negative N2 elicited by the incongruent trials and an increased (error-related negativity) ERN difference between the error and correct responses in the high-hazard condition compared to those in the low-hazard condition, implying that the monitoring of the conflict and error were both enhanced after watching the high-hazard safety signs. This study contributes to the understanding of the relationship between safety signs and cognitive control, and further expand the measurements that can be applied to assess the effectiveness of safety signs design.

Neurocognitive Profiles in Adolescence Predict Subsequent Anxiety Trajectories During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has created increased stress and anxiety for many; however, some individuals are particularly prone to heightened anxiety. It is unclear if and how prestress neurocognitive factors moderate risk for anxiety during high-stress situations. Enhanced error monitoring and a cognitive control strategy of more instantaneous (reactive) control have both been independently related to anxiety. We examined if a specific neurocognitive profile characterized by heightened error monitoring and a more reactive cognitive control strategy in adolescence predicts young adults' anxiety trajectories across 3 early months of the COVID-19 pandemic.

METHODS

As part of a longitudinal study (N = 291), data were acquired in adolescence (13 years) on error monitoring (n = 124) and cognitive control strategy (n = 119). In young adulthood (18 years), anxiety was assessed three times during the COVID-19 pandemic (n = 162).

RESULTS

On average, participants experienced greater anxiety in the first COVID-19 pandemic assessment, then anxiety decreased in the following months. Error monitoring and cognitive control strategy interacted to predict anxiety trajectories, such that among adolescents with an increased reliance on reactive control, error monitoring predicted greater anxiety in the first assessment but greater decreases the following months as stay-at-home orders were lifted and families adapted to the restrictions.

CONCLUSIONS

Results suggest that neurocognitive profiles in adolescence predict young adults' anxiety responses during a highly stressful period, such as the initial months of the COVID-19 pandemic. Our findings have implications for the early identification of individuals at greater risk for anxiety.

In the Face of Potential Harm: The Predictive Validity of Neural Correlates of Performance Monitoring for Perceived Risk, Stress, and Internalizing Psychopathology During the COVID-19 Pandemic

Background

The COVID-19 pandemic is a major life stressor posing serious threats not only to physical but also to mental health. To better understand mechanisms of vulnerability and identify individuals at risk for psychopathological symptoms in response to stressors is critical for prevention and intervention. The error-related negativity (ERN) has been discussed as a neural risk marker for psychopathology, and this study examined its predictive validity for perceived risk, stress, and psychopathological symptoms during the COVID-19 pandemic.

Methods

A total of 113 individuals who had participated as healthy control participants in previous electroencephalography studies (2014–2019) completed a follow-up online survey during the first COVID-19 wave in Germany. Associations of pre-pandemic ERN and correct-response negativity (CRN) with perceived risk regarding COVID-19 infection, stress, and internalizing symptoms during the pandemic were examined using mediation models.

Results

Pre-pandemic ERN and CRN were associated with increased perceived risk regarding a COVID-19 infection. Via this perceived risk, the ERN and CRN were associated with increased stress during the pandemic. Furthermore, risk perception and stress mediated indirect effects of ERN and CRN on internalizing psychopathology, including anxiety, depression, and obsessive-compulsive symptoms, while controlling for the effects of pre-pandemic symptom levels.

Conclusions

In summary, heightened pre-pandemic performance monitoring showed indirect associations with increases in psychopathological symptoms during the first COVID-19 wave via effects on perceived COVID-19 risk and stress. These results further strengthen the notion of performance monitoring event-related potentials as transdiagnostic neural risk markers and highlight the relevance of stress as a catalyst for symptom development.

Sex differences in neural mechanisms of social and non-social threat monitoring

Adolescent males and females differ in their responses to social threat. Yet, threat processing is often probed in non-social contexts using the error-related negativity (ERN; Flanker EEG Task), which does not yield sex-specific outcomes. fMRI studies show inconsistent patterns of sex-specific neural engagement during threat processing. Thus, the relation between threat processing in non-social and social contexts across sexes and the effects perceived level of threat on brain function are unclear. We tested the interactive effect of non-social threat-vigilance (ERN), sex (N = 69; Male=34; 11–14-year-olds), and perceived social threat on brain function while anticipating feedback from ‘unpredictable’, ‘nice’, or ‘mean’ purported peers (fMRI; Virtual School Paradigm). Whole-brain analyses revealed differential engagement of precentral and inferior frontal gyri, putamen, anterior cingulate cortex, and insula. Among males with more threat-vigilant ERNs, greater social threat was associated with increased activation when anticipating unpredictable feedback. Region of interest analyses revealed this same relation in females in the amygdala and anterior hippocampus when anticipating mean feedback. Thus, non-social threat vigilance relates to neural engagement depending on perceived social threat, but peer-based social contexts and brain regions engaged, differ across sexes. This may partially explain divergent psychosocial outcomes in adolescence.

•

Responses to social threat differ by sex and likely influence peer victimization.

•

Threat processing is often probed in nonsocial contexts and is not sex-specific.

•

Responses to type of social threat differed by sex, but relate to response to non-social threat.

•

Brain regions engaged during social threat differ by sex.

•

Perceived social threat relate to in-vivo peer victimization in both sexes.

Neurophysiological predictors of gaze-contingent music reward therapy among adults with social anxiety disorder

Social anxiety disorder (SAD) is associated with fear of negative evaluation and heightened performance monitoring. The best-established treatments help only a subset of patients, and there are no well-established predictors of treatment response. The current study investigated whether individual differences in processing errors might predict response to gaze-contingent music reward therapy (GC-MRT). At baseline, healthy control subjects (HC; n = 20) and adults with SAD (n = 29), ages 19-43 years, completed the Flanker Task while electroencephalography (EEG) data were recorded. SAD participants then received up to 12 sessions over 8 weeks of GC-MRT, designed to train participants' attention away from threatening and toward neutral faces. Clinical assessments were completed 9- (post-treatment) and 20-weeks (follow-up) after initiating the treatment. At baseline, compared to HC, SAD performed the task more accurately and exhibited increased error-related negativity (ERN) and delta power to error commission. After controlling for age and baseline symptoms, more negative ERN and increased frontal midline theta (FMT) predicted reduced self-reported social anxiety symptoms at post-treatment, and FMT also predicted clinician-rated and self-reported symptom reduction at the follow-up assessment. Hypervigilance to error is characteristic of SAD and warrants further research as a predictor of treatment response for GC-MRT.

The ERN as a neural index of changes in performance monitoring following attention training in pediatric obsessive-compulsive disorder

Evidence of associations between obsessive compulsive disorder (OCD) and alterations in neural indices of performance monitoring, i.e., elevated neural activity following errors, have accelerated interest in the error-related negativity (ERN) as a biomarker for pediatric OCD. The study investigates the degree to which attention bias training is linked to changes in neural measures of performance monitoring (ERN, correct response negativity or CRN) and whether pre-to-post training changes in these neural indices are associated with symptom changes in youth with OCD. The sample included 36 youth (8-17 years) diagnosed with OCD who completed a 12-session attention training program and pre- and post-training EEG assessment of performance monitoring using cognitive and emotional flanker tasks. The emotional flanker task was individualized to each participant's negative ratings of stimuli at pre-treatment to enhance salience of threat-related stimuli across youth. Results indicated that unlike participants who received attentional control protocol (CON), those who received attentional bias modification protocol (ABM) showed significant attenuations in neural activity following erroneous and correct responses in the emotional flanker task. The ERN amplitude during the cognitive flanker task was unchanged in both ABM and CON groups. Attenuations in the ERN were also linked to decreases in social anxiety and depressive symptoms. Findings highlight the relevance of including emotionally-salient tasks when investigating potential neural mechanisms of treatments and suggest that alterations in neural processes underlying performance monitoring can be targeted via attention training programs in pediatric OCD.

Trait anxiety modulates the temporal dynamics of Stroop task switching: An ERP study

The current study aimed to find neural evidence that trait anxiety interferes with one's shifting function processing efficiency. Twenty-five high trait-anxiety (HTA) and twenty-five low trait-anxiety (LTA) participants were instructed to complete a cue-based Stroop task-switching assessment of shifting function. No group difference in behavioral performance was shown, though event-related potential (ERP) results in the cue-locked period showed that only the LTA group had a general switch benefit in contingent negative variation (CNV) amplitude, indicating the LTA group exerted less task preparation effort. In the subsequent target-locked period, compared to the LTA group, the local switch cost of target-P3 was higher in the HTA group in incompatible trials, suggesting inefficient attentional resource allocation in the HTA group in incompatible trials. These ERP findings indicated that the HTA group ultimately achieved comparable behavioral performance with the LTA group at the expense of using more compensatory strategies at the neural level.

Emerging Domain-Based Treatments for Pediatric Anxiety Disorders

Domain-specific cognitive training treatments for pediatric anxiety disorders rely on accurate and reliable identification of specific underlying deficits and biases in neurocognitive functions. Once identified, such biases can serve as specific targets for therapeutic intervention. Clinical translations typically reflect mechanized training protocols designed to rectify the identified biases. Here, we review and synthesize research on key neurocognitive processes that emerge as potential targets for specialized cognitive training interventions in pediatric anxiety disorders in the domains of attention, interpretation, error monitoring, working memory, and fear learning. For each domain, we describe the current status of target establishment (i.e., an association between pediatric anxiety and a specific neurocognitive process), and then review extant translational efforts regarding these targets and the evidence supporting their clinical utility in youths. We then localize each of the domains within the path leading to efficacious, evidence-supported treatments for pediatric anxiety, providing a roadmap for future research. The review indicates that specific cognitive targets in pediatric anxiety have been established in all the reviewed domains except for fear learning, where a clear target is yet to be elucidated. In contrast, evidence for clinical efficacy emerged only in the threat-related attention domain, with some preliminary findings in the domains of interpretation and working memory. The path to clinical translation in the domain of error monitoring is yet unclear. Implications and potential avenues for future research and translation are discussed.

A systematic review of event-related potentials as outcome measures of attention bias modification

Attention bias modification (ABM) was initially developed with the goal of reducing attentional bias to threat-and subsequently anxious symptoms-in individuals with heightened anxiety. Although controversial, ABM appears to be generally effective in achieving this goal. Yet, the primary outcome measure of ABM (i.e., the reaction time-based differences score) has poor reliability and temporal resolution, which limits the inferences that can be drawn. In contrast, event-related potentials (ERPs) have superior reliability as well as temporal resolution and may therefore be better outcome measures of ABM. In this review, I systematically assess the research using ERPs as outcome measures in ABM protocols. I focus on the extent to which the ERPs modified by ABM represent earlier or later stages of information processing. In addition, I explore the extent to which ABM produces near and/or far transfer of learning effects on ERP measures. The reviewed literature suggests that ERPs are promising outcome measures of ABM. ABM modulates the effects of affective stimuli on posterior visually evoked ERPs (i.e., P1) as well as ERPs at anterior electrodes (i.e., P2, N2, and ERN). Based on the state of the field, several directions for future research are identified.

The Utility of Event-Related Potentials in Clinical Psychology

Event-related potentials (ERPs) are direct measures of brain activity that can be leveraged for clinically meaningful research. They can relate robustly both to continuous measures of individual difference and to categorical diagnoses in ways that clarify similarities and distinctions between apparently related disorders and traits. ERPs can be linked to genetic risk, can act as moderators of developmental trajectories and responses to stress, and can be leveraged to identify those at greater risk for psychopathology, especially when used in combination with other neural and self-report measures. ERPs can inform models of the development of, and risk for, psychopathology. Finally, ERPs can be used as targets for existing and novel interventions and prevention efforts. We provide concrete examples for each of these possibilities by focusing on programmatic research on the error-related negativity and anxiety, and thus show that ERPs are poised to make greater contributions toward the identification, prediction, treatment, and prevention of mental disorders.

The erring brain: Error-related negativity as an endophenotype for OCD-A review and meta-analysis

Obsessive-compulsive disorder (OCD) is a complex and heterogeneous disorder that is associated with high personal and societal costs. Feelings of doubt, worry, and repetitive behavior, key symptoms of OCD, have been linked to hyperactive error signals in the brain. The error-related negativity (ERN) represents a validated marker of error processing in the ERP. Increased ERN amplitudes in OCD have been reported very robustly over the last 20 years. This article integrates results from 38 studies analyzing the ERN in OCD, using a quantitative meta-analysis. Meta-regressions were used to examine potential moderators such as task type, symptom severity, age, and sample size. The meta-analysis reveals a robust increase of ERN in OCD patients compared to healthy participants in response-conflict tasks (SMD -0.55) that is not modulated by symptom severity and age. No increase in ERN in OCD was observed in tasks that do not induce response conflict (SMD -0.10). In addition to the meta-analysis, the current article reviews evidence supporting that increased ERN amplitudes in OCD fulfill central criteria for an endophenotype. Further, the specificity of increased ERN amplitudes for OCD and its suitability as a potential transdiagnostic endophenotype is discussed. Finally, the clinical utility and clinical applications are examined. Overall, the evidence that increased ERN amplitudes represent a promising endophenotype indicating vulnerability for OCD is compelling. Furthermore, alterations in ERN are not limited to OCD and may constitute a transdiagnostic endophenotype. Altered neural error signals might serve as a diagnostic or predictive marker and represent a promising target for interventions.

Intolerance of uncertainty, depression and the error-related negativity

Prior work has yielded contradictory findings regarding the association between depression and the error-related negativity (ERN), an event-related potential thought to reflect individual variation in sensitivity to internal threat (i.e., errors), and the error positivity (Pe), which is thought to reflect more elaborative, conscious processing of errors. One possibility is that variation in transdiagnostic dimensional constructs related to threat processing might help explain inconsistencies in the relationship between depression and the ERN and Pe. Here, we used a large, unselected sample (N = 100) to determine whether variation in intolerance of uncertainty (IU), a transdiagnostic trait dimension that is implicated in both depression and anxiety, might moderate associations between depressive symptomatology and error processing. Results showed that greater levels of depressive symptomatology were associated with larger ΔERNs (error minus correct trials) when IU was low, but were unrelated to ΔERN when IU was high; main effects of depression and IU on ΔERN were not observed. The Pe was not associated with IU or depression. Additionally, IU, but not depression, was associated with faster response times on error and correct trials. Overall, results suggest that error processing may differ for individuals with elevated depression with versus without elevated IU. Moreover, prior failures to observe associations between depression and the ERN might stem from failure to account for related transdiagnostic constructs.

Methodological choices in event-related potential (ERP) research and their impact on internal consistency reliability and individual differences: An examination of the error-related negativity (ERN) and anxiety

Researchers in clinical psychophysiology make several methodological decisions during the analysis of event-related potentials (ERPs). In the current study, we review these choices from the perspective of individual differences. We focus on baseline period and reference scheme (i.e., average, mastoid, current source density), as well as choices regarding where (i.e., single electrode site vs. pooling of sites), when (i.e., area, area around peak), and how (i.e., subtraction- or regression-based difference scores) to quantify ERPs. To illustrate the impact of these analytic pathways on internal consistency reliability and individual differences, we focus on the error-related negativity (ERN) and anxiety-and present data from 2 samples: 1st, in adults with diagnosed generalized anxiety disorder (GAD); 2nd, in relation to continuous self-reported symptoms of GAD in a large community sample of female adolescents. Results generally indicated similar internal consistency and between-subjects effect sizes across all evaluated methods. Nonetheless, some patterns of variation emerged, such as that, across both data sets, difference-based ERN measures, especially with mastoid reference, yielded more robust associations with GAD diagnosis and symptoms, despite somewhat lower internal consistency. The current analyses suggest that the association between ERN and anxiety is robust across a range of commonly used methodological choices. The present study is an example of how systematic analyses of analytic strategies on measures of internal consistency and between-subjects variability could help inform individual-differences ERP research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A neuromarker of clinical outcome in attention bias modification therapy for social anxiety disorder

BACKGROUND

Attention bias modification (ABM) therapy aims to modify threat-related attention patterns via computerized tasks. Despite showing medium clinical effect sizes for anxiety disorders, underlying neural-cognitive mechanisms of change remain unclear. We used visual mismatch negativity (vMMN), an event-related potential sensitive to violations of learned statistical contingencies, to assess therapy-related contingency extraction processes in healthy participants and in patients with social anxiety disorder (SAD). We then assessed whether vMMN amplitude predicts ABM treatment outcome.

METHODS

A modified version of the dot-probe task was used to elicit vMMN, in which 80% of trials were standard and 20% were deviant. In study 1, 30 healthy adults were randomly assigned to one of two ABM conditions: one in which threat-congruent targets were deviant trials and threat-incongruent targets were standard trials, and another in which the contingency was reversed. Electroencephalography (EEG) was continuously measured and vMMN analyzed. In study 2, 38 patients with SAD underwent six sessions of ABM therapy. We tested whether rule extraction in the ABM task, indicated by vMMN amplitude, predicts treatment outcome.

RESULTS

vMMN clearly emerged over prespecified scalp locations indicating contingency extraction during ABM (study 1). vMMN amplitude predicted clinical improvement after ABM therapy, uniquely accounting for 7% and 14.4% of the variance in clinician-rated and self-reported posttreatment SAD symptoms, respectively.

CONCLUSIONS

vMMN emerges as a neural marker for contingency learning in ABM, suggesting a significant role for contingency extraction processes in the clinical efficacy of this therapy.