Event-related potential studies of emotion regulation: A review of recent progress and future directions

Savoring mental imagery: Electrocortical effects and association with depression

The ability to focus on and increase positive emotion in response to mental imagery may play a key role in emotional wellbeing. Moreover, deficits in this ability might underlie emotional disorders such as depression. Here, we set out to determine whether people could use savoring to upregulate subjective and electrocortical response to mental imagery of previously viewed positive and neutral pictures, and whether this would be negatively affected by depression. On each trial, participants (N = 49) viewed a positive or neutral picture, prior to simply re-imagining the previously presented picture ("view") or re-imagining the picture while savoring it ("savor"). Results showed that savoring increased electrocortical and subjective response to imagined stimuli; however, this effect was only evident at the electrocortical level when controlling for depression. Moreover, depression moderated electrocortical findings, such that individuals who were more depressed showed a reduced effect of savoring on neural response to mental imagery. Results are in line with recent work that has shown the benefits of positive affect treatment for depression, to suggest that deficits in savoring mental imagery may play a role in the development and/or maintenance of depression.

Emotion regulation flexibility: EEG/EMG predictors and consequences of switching between reappraisal and distraction strategies

Flexible use of emotion regulation (ER) strategies is central to mental health. To advance our understanding of what drives adaptive strategy-switching decisions, in this preregistered study, we used event-related potentials (late positive potential, LPP and stimulus preceding negativity, SPN) and facial electromyography (EMG corrugator activity) to test the antecedents and consequences of switching to an alternative ER strategy. Participants (N = 63, Mage = 24.8 years, all female) passively watched and then implemented an instructed ER strategy (reappraisal or distraction) in response to high-intensity negative pictures that were either easy or difficult to reinterpret (high or low reappraisal affordance, respectively). Next, they decided to "switch from" or "maintain" the instructed strategy and subsequently implemented the chosen strategy. Reappraisal affordance manipulations successfully induced switching. Regarding antecedents, switching was predicted by the reduced ER efficacy of the current strategy (corrugator, but not LPP). Switching to distraction was additionally predicted by increased responses to the stimulus during passive viewing (corrugator and LPP) and increased anticipatory effort in implementing reappraisal (SPN). Concerning consequences, switching to distraction improved, whereas switching to reappraisal impaired post-choice ER effects (LPP). However, starting with reappraisal was overall more effective than starting with distraction, irrespective of the subsequent decision (corrugator). Our results suggest that switching between ER strategies occurs in accordance with situational demands (stimulus affordances) and is predicted by reduced peripheral physiological ER efficacy. However, only switching to distraction leads to improved regulatory effects. These insights provide neurocognitively grounded starting points for developing interventions targeting ER flexibility.

Generalization of savoring to novel positive stimuli

Savoring is a positive emotion up-regulation technique that can increase electrocortical and self-reported valence and arousal to positive and neutral pictures, with effects persisting to increase response to the same stimuli when encountered later. Outside of the lab, emotion regulation techniques that persist to affect not just encounters with the same stimuli but also encounters with similar, but previously unencountered stimuli should save individuals time and effort. Here, we used event-related potentials and picture ratings to test whether savoring would generalize to similar, but previously unseen positive pictures. To this end, 89 participants (56 female; M age = 18.96 years, SD = 1.87) were asked to savor positive pictures from one category (e.g., happy people) and to view positive pictures from another category (e.g., cute animals), as well as to view neutral pictures (e.g., plants). In a subsequent passive picture viewing task, participants viewed novel pictures from all three categories (i.e., happy people, cute animals, plants). In the first task, savoring was effective for pictures of animals throughout picture presentation, but only for pictures of people during the later part of picture presentation. In the second task, savoring generalized to novel pictures of animals, though this was only evident in the early portion of picture processing (and for self-reported ratings). Therefore, savoring holds promise as a useful technique for increasing positive emotion in everyday life, though more work is needed to understand whether effects may vary depending on different types of picture content.

Electrophysiological Correlates of Amplified Emotion-Related Cognitive Processing Evoked by Self-Administered Disgust Images

In the processing of emotions, the brain prepares and reacts in distinctive manners depending upon the negative or positive nuance of the emotion elicitors. Previous investigations showed that negative elicitors generally evoke more intense neural activities than positive and neutral ones, as reflected in the augmented amplitude of all sub-components of the event-related potentials (ERP) late posterior positivity (LPP) complex, while less is known about the emotion of disgust. The present study aimed to examine whether the LPP complex during the processing of disgust stimuli showed greater amplitude than other emotion elicitors with negative or positive valences, thus confirming it as a neural marker of disgust-related negativity bias at earlier or later stages. Thus, in the present study, we leveraged the ERP technique during the execution of an affective self-administered visual stimuli task to disentangle the neural contributions associated with images of positive, negative, disgust, or neutral emotions. Crucially, we showed that handling with disgust elicitors prompted the greatest neural activity and the highest delay during self-administration. Overall, we demonstrated progressive neural activities associated with the unpleasantness of the emotion elicitors and peculiar processing for disgust compared with all other emotions.

Brain oscillations during emotion regulation and the two-dimensional model of adult attachment

Emotion Regulation (ER) refers to the processes by which individuals influence their own emotions. It is a crucial aspect of human behavior, affecting everything from interpersonal relationships to mental health. The relationship between ER and Attachment Theory (AT) is pivotal. AT suggests that early bonds with primary caregivers influence future relationship expectations and behaviors. These initial experiences shape internal models of self and others, affecting how individuals regulate their emotions. Understanding the interplay between ER and AT is essential for comprehending the human affective system. In this study, we explored the neural underpinnings of ER, focusing on two distinct strategies: cognitive reappraisal and expressive suppression. Using electroencephalography (EEG), we examined changes in neural oscillations from 52 adults during an ER task. Specifically, we observed increased frontal theta activity (3-6 Hz) during reappraisal compared to suppression strategies. This frontal theta activity suggests enhanced cognitive control engagement. Conversely, during suppression, we noted a decrease in beta frequency (15-30 Hz) activity from central electrodes, indicative of differing neural processes. Further integrating psychological theories, we explored the relationship between these neural markers and dimensions of human attachment. Employing the Experiences in Close Relationships-12 scale (ECR-12), we identified a negative correlation between attachment anxiety and frontal theta activity. Lower levels of attachment anxiety were associated with increased theta activity, reflecting potentially more effective emotion regulation. Additionally, we found that higher theta activity corresponded with fewer difficulties in emotional control measured by the Difficulties in Emotion Regulation Scale (DERS). Regarding central beta activity, our findings revealed an interesting correlation with Emotional Inattention, a concept tied to Attachment Avoidance. This suggests that central beta activity may serve as a neural marker for specific attachment-related ER processing. These results highlight the distinct neural pathways involved in different ER strategies and their relationship with the AT and neural responses during emotional processing.

Emotion regulation unveiled through the categorical lens of attachment

BACKGROUND

Emotion regulation, the process by which individuals manage and modify their emotional experiences, expressions, and responses to adaptively navigate and cope with various situations, plays a crucial role in daily life. Our study investigates the variations in emotion regulation strategies among individuals with different attachment styles (AS). Specifically, we examine how individuals with secure, anxious, avoidant, and fearful attachment styles effectively utilize cognitive reappraisal and expressive suppression to regulate their emotions.

METHODS

A total of n = 98 adults were instructed to attend, reappraise, or suppress their emotions while viewing negative and neutral images from the International Affective Picture System (IAPS) in an experimental emotion regulation task. After completing the task, participants rated the valence and arousal elicited by the images. Attachment styles were measured using the ECR-12 questionnaire and then categorized into four AS.

RESULTS

Our study revealed that individuals with secure AS (n = 39) effectively reduced displeasure through cognitive reappraisal but experienced levels of displeasure with expressive suppression. Anxious AS (n = 16) individuals successfully reduced displeasure using cognitive reappraisal but struggled to regulate arousal and effectively use expressive suppression. Avoidant AS (n = 24) individuals could reduce displeasure with both strategies but experienced high arousal during suppression attempts. Fearful AS (n = 19) individuals effectively regulated both displeasure and arousal using either strategy. However, Secure AS individuals showed superior reappraisal efficacy, significantly reducing arousal levels compared to the Fearful AS group. Both Secure and Avoidant AS groups experienced higher valence during reappraisal relative to a baseline, indicating a decrease in displeasure.

CONCLUSIONS

Individuals with different AS exhibit variations in the effectiveness of their use of emotion regulation strategies. Our findings reinforce the significance of AS in shaping emotion regulation processes and emphasize the need for tailored approaches to support individuals with different attachment orientations.

Neurophysiological responses to emotional faces predict dynamic fluctuations in affect in adolescents

The ability to accurately identify and interpret others' emotions is critical for social and emotional functioning during adolescence. Indeed, previous research has identified that laboratory-based indices of facial emotion recognition and engagement with emotional faces predict adolescent mood states. Whether socioemotional information processing relates to real-world affective dynamics using an ecologically sensitive approach, however, has rarely been assessed. In the present study, adolescents (N = 62; ages 13-18) completed a Facial Recognition Task, including happy, angry, and sad stimuli, while EEG data were acquired. Participants also provided ecological momentary assessment (EMA) data probing their current level of happiness, anger, and sadness for 1-week, resulting in indices of emotion (mean-level, inertia, instability). Analyses focused on relations between (1) accuracy for and (2) prolonged engagement with (LPP) emotional faces and EMA-reported emotions. Greater prolonged engagement with happy faces was related to less resistance to changes in happiness (i.e., less happiness inertia), whereas greater prolonged engagement with angry faces associated with more resistance to changes in anger (i.e., greater anger inertia). Results suggest that socioemotional processes captured by laboratory measures have real-world implications for adolescent affective states and highlight potentially actionable targets for novel treatment approaches (e.g., just-in-time interventions). Future studies should continue to assess relations among socioemotional informational processes and dynamic fluctuations in adolescent affective states.

The levonorgestrel-releasing intrauterine device is related to early emotional reactivity: An ERP study

Despite the evidence of altered emotion processing in oral contraceptive (OC) users, the impact of hormonal intrauterine devices (IUD) on emotional processing remains unexplored. Our study aimed to investigate how behavioural performance and event-related potentials (ERPs) linked with emotion reactivity and its regulation are associated with hormonal profiles of women using different types of hormonal contraception and naturally cycling women. Women using OCs (n = 25), hormonal IUDs (n = 33), and naturally cycling women in their early follicular (NCF, n = 33) or mid-luteal (NCL, n = 28) phase of the menstrual cycle were instructed to view emotional pictures (neutral, low and high negativity) and use cognitive reappraisal to up- or down-regulate negative emotions, while their electroencephalogram was recorded. Participants rated perceived negativity after each picture and their emotional arousal throughout the task. Saliva samples were collected to assess levels of 17β-estradiol, progesterone, and testosterone. As expected, emotional arousal increased throughout the task and correlated positively with perceived negativity. Perceived negativity and the amplitudes of the middle (N2/P3) and later (LPP) latency ERP components increased with increasing stimuli negativity. Emotion regulation modulated perceived negativity and the amplitudes of very late ERP components (parietal and frontal LPP). Moreover, IUD-users showed a higher negative amplitude of the frontal N2 in comparison to all three other groups, with the most consistent differences during up-regulation. Finally, testosterone correlated positively with the N2 peak in IUD-users and NCL women. Overall, our findings suggest that IUD-use and testosterone might be related to altered preconscious processing during the emotion regulation task requiring attention to the stimulus. The study underscores the need for additional research into how different hormonal contraceptives are linked to socio-emotional functioning.

Emotion beliefs, emotion regulation strategies, and test anxiety of Chinese adolescents in grade 8: Evidence from physiological recordings during an exam

Controllability beliefs and goodness beliefs about emotion are two fundamental emotion beliefs. The present study considered both controllability beliefs and goodness beliefs to examine whether and how the emotion beliefs of adolescents influence their test anxiety. Besides self-reported test anxiety (sr-TA), the present study measured heart rate (HR) and galvanic skin response (GSR) using custom-designed wristbands during an exam as indicators of state test anxiety. The GSR was further decomposed into the tonic skin conductance level and the transient skin conductance response. The results revealed that, after controlling the goodness beliefs about anxiety, the controllability beliefs about emotion were negatively related to sr-TA. This relationship was mediated by suppression. The controllability beliefs about emotion were directly related to the integration of transient skin conductance responses of 5 min before the exam. They were also indirectly related to the integration of transient skin conductance responses of the exam period, whether including the 5 min before the exam or not, and HR during certain periods through suppression. Therefore, adolescents' controllability beliefs about emotion may have important implications for their test anxiety.

Mini review: Challenges in EEG emotion recognition

Electroencephalography (EEG) stands as a pioneering tool at the intersection of neuroscience and technology, offering unprecedented insights into human emotions. Through this comprehensive review, we explore the challenges and opportunities associated with EEG-based emotion recognition. While recent literature suggests promising high accuracy rates, these claims necessitate critical scrutiny for their authenticity and applicability. The article highlights the significant challenges in generalizing findings from a multitude of EEG devices and data sources, as well as the difficulties in data collection. Furthermore, the disparity between controlled laboratory settings and genuine emotional experiences presents a paradox within the paradigm of emotion research. We advocate for a balanced approach, emphasizing the importance of critical evaluation, methodological standardization, and acknowledging the dynamism of emotions for a more holistic understanding of the human emotional landscape.

Desensitized gamers? Violent video game exposure and empathy for pain in adolescents - an ERP study

This Event-Related Potential (ERP) study aimed to test how habitual and short-term violent video game exposure (VVGE) may affect empathy for pain responses in adolescents. In a within-subjects design, boys (N = 56; aged 12-16 years) performed a pain judgment task before and immediately after playing a violent video game. In this task, participants judged whether photos of hands depicted on their screen were in a painful situation or not. While both the P3 and the LPP components were not related to habitual violent video game exposure, general exposure to antisocial media content predicted lower P3 amplitudes to painful pictures. Further, 40 min of violent gameplay did not affect the P3 responses; however, it temporarily decreased LPP responses to painful pictures, suggesting a modest short-term desensitization effect. However, this latter interpretation is limited by a strong LPP pain effect - a significant amplitude difference between painful and non-painful pictures - that remained present in the post-game condition. Such persistent LPP effect may relate to the notion that adolescents are still learning how to properly regulate their emotional reactions. This study contributes to the limited literature on violent video games' desensitization in adolescents' brains, opening new avenues for media violence research.

Positive emotion up-regulation is resistant to working memory load: An electrocortical investigation of reappraisal and savoring

Studies of emotion regulation to-date have mostly focused on negative emotion down-regulation, leaving positive emotion up-regulation poorly understood, particularly regarding factors that may modulate its success. While reappraisal and savoring have been shown to be effective at increasing electrocortical and subjective response to pictures in controlled laboratory settings, it remains unclear whether individuals can effectively enact these techniques to willfully increase positive emotions in everyday life when faced with other concurrent distractions/demands. Here, we used the late positive potential (LPP), an electrocortical measure that is larger for emotional compared to neutral stimuli, to assess the effect of working memory (WM) load on individuals' ability to reappraise or savor positive pictures. Seventy-six participants were randomly assigned to use either reappraisal or savoring to up-regulate positive emotion to pictures. Following training, participants engaged in a positive emotion up-regulation task interspersed with high and low WM load trials, while EEG was recorded. Frequentist and Bayesian statistics showed that although high WM load seemed to consume resources and reduced picture processing overall, it did not interfere with the enhancement of the LPP via positive emotion up-regulation. Nonetheless, WM performance (especially on high-load trials) was worse when participants were engaged in positive emotion up-regulation. Therefore, while both techniques appear to be effective under concurrent WM load, positive emotion up-regulation may interfere with other ongoing tasks.

An Examination of the Association between Emotion Regulation and Emetophobia Symptoms

BACKGROUND

Specific phobia of vomiting, referred to as emetophobia, is a specific phobia characterized by persistent and severe fear of vomit. Individuals with emetophobia engage in a variety of emotional and behavioral avoidance strategies to distance themselves from perceived vomit-related threat. As such, individuals may struggle to effectively use emotion regulation (ER) skills; however, to date, limited work has examined the association between emotion regulation and emetophobia symptoms. The present study aimed to address this gap in the literature and examine the association between ER and emetophobia symptoms.

METHODS

Participants (N = 508) were a remote, clinical sample of individuals recruited via social media forums dedicated to the disorder who self-identified as experiencing emetophobia. Hierarchical linear regressions were used to assessed unique contributions of ER to emetophobia symptoms. Age, gender, and depressive symptoms were entered as covariates in the hierarchical regression.

RESULTS

Results demonstrated ER was significantly related to emetophobia symptoms above and beyond the effects of depressive symptoms, age and gender in the current sample.

CONCLUSIONS

The findings provide initial support for an association between ER and emetophobia, and suggest future directions for refining the conceptualization of emetophobia. Limitations and considerations include the recruitment strategy via social media websites for individuals with emetophobia, limited diversity of the sample, and cross-sectional nature.

Architectural experience influences the processing of others' body expressions

The interplay between space and cognition is a crucial issue in Neuroscience leading to the development of multiple research fields. However, the relationship between architectural space and the movement of the inhabitants and their interactions has been too often neglected, failing to provide a unifying view of architecture's capacity to modulate social cognition broadly. We bridge this gap by requesting participants to judge avatars' emotional expression (high vs. low arousal) at the end of their promenade inside high- or low-arousing architectures. Stimuli were presented in virtual reality to ensure a dynamic, naturalistic experience. High-density electroencephalography (EEG) was recorded to assess the neural responses to the avatar's presentation. Observing highly aroused avatars increased Late Positive Potentials (LPP), in line with previous evidence. Strikingly, 250 ms before the occurrence of the LPP, P200 amplitude increased due to the experience of low-arousing architectures, reflecting an early greater attention during the processing of body expressions. In addition, participants stared longer at the avatar's head and judged the observed posture as more arousing. Source localization highlighted a contribution of the dorsal premotor cortex to both P200 and LPP. In conclusion, the immersive and dynamic architectural experience modulates human social cognition. In addition, the motor system plays a role in processing architecture and body expressions suggesting that the space and social cognition interplay is rooted in overlapping neural substrates. This study demonstrates that the manipulation of mere architectural space is sufficient to influence human social cognition.

Reappraisal is less effective than distraction in downregulation of neural responses to physical threats-An event-related potential investigation

Evolutionary threats (ETs), such as predatory animals and heights, elicit stronger fear responses and are more often the subject of specific phobias, as compared to modern threats (MTs, such as guns and motorcycles). Since processing of ET depends on lower-order, phylogenetically conserved neural fear circuits, it may be less susceptible to higher-order (vs. simpler) cognitive emotion regulation. Given the relevance for treatment of specific phobias, we tested this hypothesis in an ERP study. Sixty-one female participants passively watched high- and low-threat pictures of evolutionary (snakes, lizards) and modern (guns, water-guns) origin, and downregulated responses to the high-threat pictures (snakes and guns) using either cognitive reappraisal or a simpler cognitive distraction strategy. ET elicited stronger early (EPN) and sustained (LPP) attention processing compared to MT. Both strategies successfully downregulated subjective and LPP (but not EPN) responses compared to passive watching. Although reappraisal was more effective subjectively, distraction downregulated the LPP earlier and stronger than reappraisal, irrespective of the threat type. These findings provide novel evidence that neural responses to physical threat might be less susceptible to cognitive emotion regulation via higher-order (reappraisal) versus simpler (distraction) strategies, irrespective of the evolutionary or modern relevance of threat. Combining both strategies could be beneficial for the emotion regulation-enhancing interventions for specific phobias. Distraction could be used during initial exposure, to reduce immediate emotion responding and help endure the contact with the feared stimulus, whereas reappraisal could be used subsequently, when emotions are less intense, to change maladaptive thoughts about the stimulus for future encounters.

Weathering the storm of emotions: immediate and lasting effects of reinterpretation and distancing on event-related potentials and their association with habitual use of cognitive reappraisal

Reinterpretation and distancing, two cognitive reappraisal tactics, are known to effectively reduce negative feelings and event-related potentials (ERPs), such as the P300 and the late positive potential (LPP), in the short-term. Less is known about differential and lasting effects on ERPs as well as their association with habitual reappraisal. Fifty-seven participants were instructed to passively view or reappraise (reinterpretation, distancing) pictures that were repeatedly presented with the same instruction (active regulation phase). Thirty minutes later, these pictures were shown again without instruction for the assessment of lasting effects (re-exposure phase). ERPs were recorded and participants rated the intensity of negative feelings following picture presentation. Reappraisal led to an attenuation of the LPP, and both tactics decreased negative feelings during active regulation, whereby reinterpretation had a stronger impact on the subjective level. Passive re-exposure resulted in reduced negative feelings for previously reappraised pictures but had no lasting effects on ERPs. Higher habitual reappraisal was associated with higher P300 and early LPP amplitudes for emotional reactivity during the active regulation phase. During the re-exposure phase, higher habitual reappraisal was not related to ERPs. The current findings emphasize the effectiveness of both tactics in the short-term and lasting effects on the subjective experience of negative feelings. Enhanced emotional reactivity on the electrocortical level in individuals with a more frequent habitual use of reappraisal might indicate a higher preparedness to regulate.

Catch the drift: Depressive symptoms track neural response during more efficient decision-making for negative self-referents

Background

Adolescence is a time of heightened risk for developing depression and also a critical period for the development and integration of self-identity. Despite this, the relation between the neurophysiological correlates of self-referential processing and major depressive symptoms in youth is not well understood. Here, we leverage computational modeling of the self-referential encoding task (SRET) to identify behavioral moderators of the association between the posterior late positive potential (LPP), an event-related potential associated with emotion regulation, and youth self-reported symptoms of depression. Specifically, within a drift-diffusion framework, we evaluated whether the association between the posterior LPP and youth symptoms of major depression was moderated by drift rate, a parameter reflecting processing efficiency during self-evaluative decisions.

Methods

A sample of 106 adolescents, aged 12 to 17 (53% male; Mage = 14.49, SD = 1.70), completed the SRET with concurrent high-density electroencephalography and self-report measures of depression and anxiety.

Results

Findings indicated a significant moderation: for youth showing greater processing efficiency (drift rate) when responding to negative compared to positive words, larger posterior LPPs predicted greater depressive symptom severity.

Limitations

We relied on a community sample and our study was cross-sectional in nature. Future longitudinal work with clinically depressed youth would be beneficial.

Conclusions

Our results suggest a neurobehavioral model of adolescent depression wherein efficient processing of negative information co-occurs with increased demands on affective self-regulation. Our findings also have clinical relevance; youth's neurophysiological response (posterior LPP) and performance during the SRET may serve as a novel target for tracking treatment-related changes in one's self-identity.

Successful emotion regulation via cognitive reappraisal in authentic pride: Behavioral and event-related potential evidence

The present study explored whether authentic pride (AP) and hubristic pride (HP) were differently associated with cognitive reappraisal strategy. In study 1, undergraduates (n = 235) completed a battery of self-report questionnaires, including the Authentic and Hubristic Pride-Proneness Scale (AHPPS), Emotion Regulation Questionnaire (ERQ), and emotion regulation questionnaire (ERP-R). The results showed that AP significantly predicted successful down-regulation of negative emotions via a spontaneous cognitive reappraisal strategy. However, hubristic pride (HP) was negatively associated with spontaneous cognitive reappraisal. In study 2, participants with trait AP (n = 31) and trait HP (n = 29) undergoing continuous electroencephalogram (EEG) recording were required to reinterpret emotional pictures to down-regulate/up-regulate their negative/positive emotional reactions. The results showed that individuals with AP reported lower levels of emotional arousal and lower amplitudes of late positive potentials (LPPs) than did individuals with HP in response to negative pictures during the down-regulation of negative emotions, but not during passive viewing or up-regulation of positive emotions. Across two studies, these findings showed that individuals with AP could utilize the cognitive reappraisal strategy (spontaneously in daily life and under experimental instructions) to down-regulate negative emotions more successfully relative to individuals with HP.

Emotion regulation strategies differentially modulate neural activity across affective prediction stages: An HD-EEG investigation

Emotion regulation (ER) strategies can influence how affective predictions are constructed by the brain (generation stage) to prearrange action (implementation stage) and update internal models according to incoming stimuli (updating stage). However, neurocomputational mechanisms by which this is achieved are unclear. We investigated through high-density EEG if different ER strategies (expressive suppression vs. cognitive reappraisal) predicted event-related potentials (ERPs) and brain source activity across affective prediction stages, as a function of contextual uncertainty. An S1-S2 paradigm with emotional faces and pictures as S1s and S2s was presented to 36 undergraduates. Contextual uncertainty was manipulated across three blocks with 100, 75, or 50% S1-S2 affective congruency. The effects of ER strategies, as assessed through the Emotion Regulation Questionnaire, on ERP and brain source activity were tested for each prediction stage through linear mixed-effects models. No ER strategy affected prediction generation. During implementation, in the 75% block, a higher tendency to suppress emotions predicted higher activity in the left supplementary motor area at 1,500–2,000 ms post-stimulus, and smaller amplitude of the Contingent Negative Variation at 2,000–2,500 ms. During updating, in the 75% block, a higher tendency to cognitively reappraise emotions predicted larger P2, Late Positive Potential, and right orbitofrontal cortex activity. These results suggest that both ER strategies interact with the levels of contextual uncertainty by differently modulating ERPs and source activity, and that different strategies are deployed in a moderately predictive context, supporting the efficient updating of affective predictive models only in the context in which model updating occurs.

Neural correlates of emotional reactivity predict response to cognitive-behavioral therapy in obsessive-compulsive disorder

BACKGROUND

Examining predictive biomarkers to identify individuals who will likely benefit from a specific treatment is important for the development of targeted interventions. The late positive potential (LPP) is a neural marker of attention and elaborated stimulus processing, and increased LPP responses to negative stimuli are characteristic of pathological anxiety. The present study investigated whether LPP reactivity would prospectively predict response to cognitive-behavioral therapy (CBT), the first-line treatment for obsessive-compulsive disorder (OCD).

METHODS

To this end, the LPP in response to negative as compared to neutral pictures was examined in 45 patients with OCD, who underwent CBT in a naturalistic outpatient setting. LPP amplitudes were used as predictors of symptom reduction after CBT.

RESULTS

We found that higher LPP amplitudes to negative relative to neutral stimuli were predictive of lower self-reported OCD symptoms after completion of CBT, controlling for pre-treatment symptoms. Further, LPP reactivity was negatively correlated with self-reported habitual use of suppression in everyday life.

LIMITATIONS

Some participants had already begun treatment at the time of study participation. Overall, results need further replication in larger samples and standardized therapy settings.

CONCLUSIONS

The current findings suggest that patients with increased emotional reactivity benefit more from CBT, possibly through less avoidance of anxiety-provoking stimuli during exposure with response prevention, a crucial component in CBT for OCD. Although its clinical utility still needs to be evaluated further, the LPP constitutes a promising candidate as a prognostic marker for CBT response in OCD.