EEG correlates of attentional control in anxiety disorders: A systematic review of error-related negativity and correct-response negativity findings

The Balance N1 Is Larger in Children With Anxiety and Associated With the Error-Related Negativity

Background

The error-related negativity (ERN) is a brain response evoked by mistakes in cognitive tasks that is enhanced with anxiety and can predict the subsequent onset or exacerbation of anxiety in children and adolescents. A physical disturbance to standing balance evokes a brain response called the balance N1 that resembles the ERN in scalp topography and in response to a variety of moderating factors. We recently found that the balance N1 and ERN correlate in amplitude across small samples of adults.

Methods

In the current study, we tested the effect of anxiety on the balance N1 in children (ages 9-12 years) with and without diagnosed anxiety disorders (38 children with generalized anxiety, social anxiety, and/or obsessive-compulsive disorder and 50 children without these disorders). We measured the balance N1 in response to sudden release of support from a forward leaning posture, the ERN in response to mistakes on a Go/NoGo task, and anxiety symptoms using child- and parent-report forms of the Screen for Child Anxiety and Related Emotional Disorders.

Results

Both the balance N1 and the ERN were larger in the anxious group. The balance N1 was also associated with both the ERN and parent report of child anxiety symptom severity across individuals.

Conclusions

The higher measurement reliability of the balance N1 than the ERN and greater experimental control over errors suggest that balance paradigms may provide a more powerful method for investigating individual differences in error-related brain activity related to anxiety.

The role of children's neural responses to emotional faces in the intergenerational transmission of anxiety symptomatology

Children's neural responses to emotions may play a role in the intergenerational transmission of anxiety. In a prospective longitudinal study of a community sample of N = 464 mother-child dyads, we examined relations among maternal anxiety symptoms when children were infants and age 5 years, child neural responses to emotional faces (angry, fearful, happy) at age 3 years, and child internalizing symptoms at age 5 years. Path analyses tested whether amplitudes of event-related potential (ERP) components selected a priori (N290, Nc, P400) (a) mediated associations between maternal anxiety symptoms in infancy and child internalizing symptoms at 5 years and/or (b) moderated associations between maternal anxiety symptoms at 5 years and child internalizing symptoms at 5 years. Mediating effects were not observed for any of the ERP measures. Nc and P400 amplitudes to angry faces and Nc amplitude to happy faces moderated the effect of maternal anxiety at 5 years on child internalizing symptoms at 5 years. Effects were not related to maternal depressive symptoms. Differential sex effects were not observed. The findings suggest that larger neural responses to emotional faces may represent a biological risk factor that amplifies vulnerability to the development of internalizing symptomatology in young children exposed to maternal anxiety.

Aberrant error monitoring in traumatic brain injuries: A meta-analysis of event-related potential studies

OBJECTIVE

Although individuals with traumatic brain injuries (TBI) often manifest altered error monitoring, evidence using event-related potentials (ERPs) to index these cortical processes is inconsistent. Therefore, this meta-analysis study aimed to comprehensively compare the error-related negativity (ERN) and error positivity (Pe) between individuals with TBI and healthy controls (HC) from the existing literature.

METHODS

Literature search was performed using PubMed/MEDLINE, Web of Science, and Cochrane Library. The effect sizes (Hedges' g) in the comparisons of ERN and Pe amplitudes between TBI and HC groups were employed by a random-effect, inverse-variance weighted model. The effects of age, TBI severity and experimental tasks on both ERP components were also examined.

RESULTS

Random-effect models showed decreased ERN (g = 0.361, p = 0.010), but intact Pe (g = 0.105, p = 0.443), in those with TBI compared to HC. A further analysis revealed that the adult patients (g = 0.326, p = 0.038), but not the youth patients, showed significant reduction of ERN as compared to the HC. However, we did not find moderating effects of TBI severity and experimental paradigms on either ERN or Pe.

CONCLUSIONS

ERN and Pe reflect separate neurophysiological mechanisms and different aspects of error monitoring in TBI. Our findings suggest that attenuated ERN amplitude may be an electrophysiological parameter of error monitoring deficits in TBI.

Quantitative EEG and its relationship with attentional control in patients with anxiety disorders

Introduction

Attentional control is crucial in the development and maintenance of anxiety disorders. Understanding the underlying mechanisms of attentional control can help to shed light on the neuropathological processes in anxiety disorders (ANX). Quantitative electroencephalography (QEEG) offers a cost-effective, noninvasive method for examining the neuropathological mechanisms of mental disorders.

Methods

In this study, 67 patients with ANX and 45 healthy controls (HC) were recruited. EEG recordings were obtained for 5 minutes in an eyes-closed condition. QEEG was employed to evaluate the mechanisms of attentional control in ANX.

Results

Neurophysiological measures indicated that anxiety patients exhibited a more frontal topographic pattern of theta/beta ratio (TBR) compared to HC. Additionally, a significant decrease in temporal beta power was observed in the ANX group. Correlation analysis revealed that decreased beta power and increased TBR were significant association between attentional control deficits in ANX.

Discussion

These findings provide electrophysiological evidence of impaired attentional control processing in anxiety patients, characterized by decreased temporal beta power and increased frontal TBR. Temporal beta power and frontal TBR may serve as promising biomarkers for attentional control in ANX.

Adversity and error-monitoring: Effects of emotional context

This study tested whether self-reports of childhood adversity would predict altered error processing under emotional versus non-emotional task conditions. N = 99 undergraduates completed two selective attention tasks, a traditional color-word Stroop task and a modified task using emotional words, while EEG was recorded. Participants also completed self-report measures of adverse and positive childhood experiences, executive functioning, depression, current stress, and emotion regulation. Reports of adversity were robustly correlated with self-reported challenges in executive functioning, even when controlling for self-reported depression and stress, but adversity was not correlated with task performance. With regard to neural markers of error processing, adversity predicted an enhanced error-related negativity and blunted error-positivity, but only during the emotion-word blocks of the task. Moreover, error-related changes in alpha oscillations were predicted by adversity, in a pattern that suggested less error responsiveness in alpha patterns during the emotion block, compared to the color block, among participants with higher adversity. Overall, results indicate alterations in error monitoring associated with adversity, such that in an emotional context, initial error detection is enhanced and sustained error processing is blunted, even in the absence of overt performance changes.

Risk avoidance and social anxiety in adolescence: Examination of event-related potentials and theta-dynamics on the Balloon Risk Avoidance Task

Adolescents are at relatively high-risk for developing anxiety, particularly social anxiety. A primary hallmark of social anxiety is the impulse to avoid situations that introduce risk. Here, we examined the neural and behavioral correlates of risk avoidance in adolescents (N=59) 11 to 19 years of age. The Balloon Risk Avoidance Task was used with concurrent electroencephalography to measure event-related potentials (frontal P2; late slow-wave; N2, feedback-related negativity, FRN; posterior P3) and oscillatory dynamics (midfrontal theta, 4-7 Hz) in response to unsuccessful and successful risk avoidance conditions. Social anxiety was measured using the Social Phobia and Anxiety Inventory for Children. Results indicated that, across the whole sample, youth exhibited smaller P3, larger FRN, and larger theta responses to unsuccessful risk avoidance. Youth reporting high (compared to low) levels of social anxiety exhibited larger P2, slow-wave, and FRN responses to unsuccessful, compared to successful, risk avoidance. Further, greater social anxiety was associated with reduced theta responses to successful avoidance. Youth with higher levels of social anxiety showed smaller theta responses to both conditions compared to those with low levels of social anxiety. Taken together, the ERP-component differences and weakened theta power in socially anxious youth following unsuccessful avoidance are informative neural correlates for socially anxious youth during risk avoidance.

Physiological correlates of anxiety in childhood and adolescence: A systematic review and meta-analysis

Anxiety is one of the most prevalent problems that affects children and adolescents. The vast majority of diagnostic tools for anxiety depend on written or verbal reports from children and adolescents or their significant others. The validity and reliability of such reports can be compromised by their subjective nature. Thus, there is growing interest in whether anxiety can be indexed with objective physiological measures. The key aim of this systematic review and meta-analysis was to determine which physiological measures are most reliably associated with elevated levels of anxiety amongst children and adolescents. Online databases (e.g., PsycINFO, Embase, Medline) were searched for relevant studies according to pre-determined criteria. Twenty-five studies comprising 2502 participants (N = 1160 with high anxiety) met inclusion, identifying 11 groups of physiological measures. Our meta-analysis revealed that skin conductance level is the most sensitive measure of anxiety (d = 0.83), followed by electromyography (EMG) measures (d = 0.71) and skin conductance response (d = 0.58). However, the included studies varied in terms of subjective measures, study designs, experimental task measures, and physiological measures. Consideration of these differences in methodology offer potential directions for future research.

A biomarker discovery framework for childhood anxiety

Introduction

Anxiety is the most common manifestation of psychopathology in youth, negatively affecting academic, social, and adaptive functioning and increasing risk for mental health problems into adulthood. Anxiety disorders are diagnosed only after clinical symptoms emerge, potentially missing opportunities to intervene during critical early prodromal periods. In this study, we used a new empirical approach to extracting nonlinear features of the electroencephalogram (EEG), with the goal of discovering differences in brain electrodynamics that distinguish children with anxiety disorders from healthy children. Additionally, we examined whether this approach could distinguish children with externalizing disorders from healthy children and children with anxiety.

Methods

We used a novel supervised tensor factorization method to extract latent factors from repeated multifrequency nonlinear EEG measures in a longitudinal sample of children assessed in infancy and at ages 3, 5, and 7 years of age. We first examined the validity of this method by showing that calendar age is highly correlated with latent EEG complexity factors (r = 0.77). We then computed latent factors separately for distinguishing children with anxiety disorders from healthy controls using a 5-fold cross validation scheme and similarly for distinguishing children with externalizing disorders from healthy controls.

Results

We found that latent factors derived from EEG recordings at age 7 years were required to distinguish children with an anxiety disorder from healthy controls; recordings from infancy, 3 years, or 5 years alone were insufficient. However, recordings from two (5, 7 years) or three (3, 5, 7 years) recordings gave much better results than 7 year recordings alone. Externalizing disorders could be detected using 3- and 5 years EEG data, also giving better results with two or three recordings than any single snapshot. Further, sex assigned at birth was an important covariate that improved accuracy for both disorder groups, and birthweight as a covariate modestly improved accuracy for externalizing disorders. Recordings from infant EEG did not contribute to the classification accuracy for either anxiety or externalizing disorders.

Conclusion

This study suggests that latent factors extracted from EEG recordings in childhood are promising candidate biomarkers for anxiety and for externalizing disorders if chosen at appropriate ages.

Cognitive Neuroscience of Obsessive-Compulsive Disorder

Cognitive neuroscientific research has the ability to yield important insights into the complex neurobiological processes underlying obsessive-compulsive disorder (OCD). This article provides an updated review of neuroimaging studies in seven neurocognitive domains. Findings from the literature are discussed in the context of obsessive-compulsive phenomenology and treatment. Expanding our knowledge of the neural mechanisms involved in OCD could help optimize treatment outcomes and guide the development of novel interventions.

Anxiety disrupts performance monitoring: integrating behavioral, event-related potential, EEG microstate, and sLORETA evidence

Anxiety impacts performance monitoring, though theory and past research are split on how and for whom. However, past research has often examined either trait anxiety in isolation or task-dependent state anxiety and has indexed event-related potential components, such as the error-related negativity or post-error positivity (Pe), calculated at a single node during a limited window of time. We introduced 2 key novelties to this electroencephalography research to examine the link between anxiety and performance monitoring: (i) we manipulated antecedent, task-independent, state anxiety to better establish the causal effect; (ii) we conducted moderation analyses to determine how state and trait anxiety interact to impact performance monitoring processes. Additionally, we extended upon previous work by using a microstate analysis approach to isolate and sequence the neural networks and rapid mental processes in response to error commission. Results showed that state anxiety disrupts response accuracy in the Stroop task and error-related neural processes, primarily during a Pe-related microstate. Source localization shows that this disruption involves reduced activation in the dorsal anterior cingulate cortex and compensatory activation in the right lateral prefrontal cortex, particularly among people high in trait anxiety. We conclude that antecedent anxiety is largely disruptive to performance monitoring.

Neural indices of performance monitoring are associated with daily emotional functioning in youth with anxiety disorders: An ERP and EMA study

Excessive monitoring of one's performance is a characteristic of anxiety disorders that has been linked to alterations in implicit emotion regulation (ER), including elevations in neural measures of performance monitoring (i.e., error- and correct-related negativity; ERN and CRN). Elevations in ERN and CRN amplitudes have been reported consistently in anxiety disorders, suggesting that an overactive performance monitoring system is linked to ER difficulties in anxiety. Yet, the relevance of these lab-based neural measures for day-to-day emotional functioning remains poorly understood. This study examined the degree to which ERN and CRN amplitudes are associated with measures of daily ER difficulties in youth with anxiety disorders. Youth (N = 100, Mage = 11.14, SDage = 1.46) completed a computerized flanker task assessing the ERN and CRN. They then completed a 5-day ecological momentary assessment (EMA) protocol assessing their daily ER (i.e., intensity of momentary and peak negative affect, intensity of worry, reliance on maladaptive ER strategies). Results showed that more negative mean CRN amplitudes were associated with higher levels of negative emotional reactivity and more intense worries. There were no significant associations between ERN amplitude and EMA measures. Furthermore, elevations in CRN were linked to more frequent use of maladaptive ER strategies (i.e., rumination, physiological reactivity, avoidance). Together, results indicate that among youth with anxiety, individual differences in CRN, but not ERN, amplitudes are related to daily ER difficulties. Findings highlight the clinical utility of a lab-based neural measure of ER, suggesting that the CRN, rather than the ERN, reflects individual ER differences in the context of daily life among youth with pediatric anxiety disorders. As such, the CRN might serve as an important dimensional index of a treatment target that can be tracked with a validated, multi-method measure.

Altered performance monitoring in Tourette Syndrome: an MEG investigation

The error-related negativity (ERN) is an event-related potential component indexing processes of performance monitoring during simple stimulus-response tasks: the ERN is typically enhanced for error processing and conflicting response representations. Investigations in healthy participants and different patient groups have linked the ERN to the dopamine system and to prefrontal information processing. As in patients with Tourette Syndrome (TS) both dopamine release and prefrontal information processing are impaired, we hypothesized that performance monitoring would be altered, which was investigated with magnetencephalography (MEG). We examined performance monitoring in TS patients by assessing the magnetic equivalent of the ERN (mERN). The mERN was investigated in tic-free trials of eight adult, unmedicated TS patients without clinically significant comorbidity and ten matched healthy controls while performing a Go/NoGo task in selected frontocentral channels. The analysis of the response-related amplitudes of the event-related magnetic field showed that TS patients, in contrast to controls, did not show earlier amplitude modulation (between 70 and 105 ms after response onset) depending on response type (errors or correct responses). In both groups significant mERN amplitudes in the time-window between 105 and 160 ms after response onset were detected thus pointing at only later error processing in TS patients. In TS patients, early error-related processing might be affected by an enhanced motor control triggered by a conflict between the targeted high task performance and tic suppression. TS patients seem to tend to initially process all responses as erroneous responses.

Non-invasive brain stimulation modulates neural correlates of performance monitoring in patients with obsessive-compulsive disorder

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Effects of tDCS on performance monitoring examined in OCD and healthy individuals.

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A preregistered, randomized, sham-controlled tDCS–EEG study was conducted.

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Cathodal tDCS over the pre-SMA reduced the error-related negativity (ERN).

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Correct-response negativity was enhanced, error positivity reduced by cathodal tDCS.

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The findings substantiate the role of the ERN as a target for new interventions.

Overactive performance monitoring, as reflected by enhanced neural responses to errors (the error-related negativity, ERN), is considered a biomarker for obsessive-compulsive disorder (OCD) and may be a promising target for novel treatment approaches. Prior research suggests that non-invasive brain stimulation with transcranial direct current stimulation (tDCS) may reduce the ERN in healthy individuals, yet no study has investigated its efficacy in attenuating the ERN in OCD. In this preregistered, randomized, sham-controlled, crossover study, we investigated effects of tDCS on performance monitoring in patients with OCD (n = 28) and healthy individuals (n = 28). Cathodal and sham tDCS was applied over the presupplementary motor area (pre-SMA) in two sessions, each followed by electroencephalogram recording during a flanker task. Cathodal tDCS reduced the ERN amplitude compared to sham tDCS, albeit this effect was only marginally significant (p = .052; mean difference: 0.86 μV). Additionally, cathodal tDCS reduced the correct-response negativity and increased the error positivity. These neural modulations were not accompanied by behavioral changes. Moreover, we found no evidence that the tDCS effect was more pronounced in the patient group. In summary, our findings indicate that tDCS over the pre-SMA modulates neural correlates of performance monitoring across groups. Therefore, this study represents a valuable starting point for future research to determine whether repeated tDCS application induces a more pronounced ERN attenuation and normalizes aberrant performance monitoring in the long term, thereby potentially alleviating obsessive-compulsive symptoms and providing a psychophysiological intervention strategy for individuals who do not benefit sufficiently from existing interventions.