The role of hand of error and stimulus orientation in the relationship between worry and error-related brain activity: Implications for theory and practice

A registered report of a two-site study of variations of the flanker task: ERN experimental effects and data quality

Error-related negativity is a widely used measure of error monitoring, and many projects are independently moving ERN recorded during a flanker task toward standardization, optimization, and eventual clinical application. However, each project uses a different version of the flanker task and tacitly assumes ERN is functionally equivalent across each version. The routine neglect of a rigorous test of this assumption undermines efforts to integrate ERN findings across tasks, optimize and standardize ERN assessment, and widely apply ERN in clinical trials. The purpose of this registered report was to determine whether ERN shows similar experimental effects (correct vs. error trials) and data quality (intraindividual variability) during three commonly used versions of a flanker task. ERN was recorded from 172 participants during three versions of a flanker task across two study sites. ERN scores showed numerical differences between tasks, raising questions about the comparability of ERN findings across studies and tasks. Although ERN scores from all three versions of the flanker task yielded high data quality and internal consistency, one version did outperform the other two in terms of the size of experimental effects and the data quality. Exploratory analyses of the error positivity (Pe) provided tentative support for the other two versions of the task over the paradigm that appeared optimal for ERN. The present study provides a roadmap for how to statistically compare psychometric characteristics of ERP scores across paradigms and gives preliminary recommendations for flanker tasks to use for ERN- and Pe-focused studies.

Flanker task parameters are related to the strength of association between the ERN and anxiety: a meta-analysis

The error-related negativity (ERN)-an index of error monitoring-is associated with anxiety symptomatology. Although recent work suggests associations between the ERN and anxiety are relatively modest, little attention has been paid to how variation in task parameters may influence the strength of ERN-anxiety associations. To close this gap, the current meta-analysis assesses the possible influence of task parameter variation in the Flanker task-the most commonly used task to elicit the ERN-on observed ERN-anxiety associations. Here, we leveraged an existing open database of published/unpublished ERN-anxiety effect sizes, supplementing this database by further coding for variation in stimulus type (letter vs. arrow), response type (one-handed vs. two-handed), and block-level feedback (with vs. without). We then performed meta-regression analyses to assess whether variation in these Flanker task parameters moderated the effect size of ERN-anxiety associations. No evidence for an effect of stimulus type was identified. However, both response type and block-level feedback significantly moderated the magnitude of ERN-anxiety associations. Specifically, studies employing either a two-handed (vs. one-handed) task, or those with (vs. without) block-level feedback exhibited more than a two-fold increase in the estimated ERN-anxiety effect size. Thus, accounting for common variation in task parameters may at least partially explain apparent inconsistencies in the literature regarding the magnitude of ERN-anxiety associations. At a practical level, these data can inform the design of studies seeking to maximize ERN-anxiety associations. At a theoretical level, the results also inform testable hypotheses regarding the exact nature of the association between the ERN and anxiety.

Response monitoring in math-anxious individuals in an arithmetic task

We examine whether math anxiety is related to altered response monitoring in an arithmetic task. Response-locked event-related brain potentials (ERPs) were evaluated in 23 highly (HMA) and 23 low math-anxious (LMA) individuals while they performed an arithmetic verification task. We focused on two widely studied ERPs elicited during error processing: error-related negativity (ERN) and error positivity (Pe). Correct-related negativity (CRN), an ERP elicited after a correct response, was also studied. The expected ERN following errors was found, but groups did not differ in its amplitude. Importantly, LMA individuals showed less negative CRN and more positive Pe amplitudes than their more anxious peers, suggesting more certainty regarding response accuracy and better adaptive behavioral adjustment after committing errors in an arithmetic task in the LMA group. The worse control over response performance and less awareness of correct responses in the HMA group might reduce their ability to 'learn from errors'.

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study

AIMS

The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic.

DESIGN

This was a phenomenological study, and qualitative descriptive analysis was used.

METHODS

New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method.

RESULTS

Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles.

CONCLUSIONS

New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Post-error slowing in anxiety and obsessive-compulsive disorders

Altered brain response to errors in anxiety and obsessive-compulsive disorders (OCD) suggests cognitive control abnormalities across both types of illness, but behavioral metrics of cognitive control function have yet to be compared in patients selected from these different diagnostic categories. Thus, we examined post-error slowing (PES), a behavioral adjustment that typically occurs after a mistake, in children and adolescents with and without a primary anxiety disorder (N = 103 anxiety and N = 28 healthy controls) and adolescents and adults with and without OCD (N = 118 OCD and N = 60 healthy controls) using a go/no-go task. Primary analyses tested for differences in PES between diagnostic groups (anxiety, OCD, healthy), controlling for age, overall reaction time, and overall accuracy. Results indicated that patients with anxiety disorders exhibited more post-error slowing than both patients with OCD and healthy volunteers. In contrast, participants with OCD did not differ from healthy volunteers in post-error slowing. In subgroup analyses restricted to adolescent participants (ages 13-17 years), more post-error slowing was observed in the anxiety disorders group compared with either the OCD or healthy groups. These data suggest that excessive post-error slowing, an index of behavioral adjustment following errors, may uniquely characterize patients with anxiety disorders relative to healthy individuals and those with OCD.

Disentangling the effects of trait and state worry on error-related brain activity: Results from a randomized controlled trial using worry manipulations

Enhanced amplitudes of the error-related negativity (ERN) have been suggested to be a transdiagnostic neural risk marker for internalizing psychopathology. Previous studies propose worry to be an underlying mechanism driving the association between enhanced ERN and anxiety. The present preregistered study focused on disentangling possible effects of trait and state worry on the ERN by utilizing a cross sectional observational and a longitudinal randomized controlled experimental design. To this end, we examined the ERN of n = 90 students during a flanker task (T0), which were then randomly assigned to one of three groups (worry induction, worry reduction, passive control group). Following the intervention, participants performed another flanker task (T1) to determine potential alterations of their ERN. Manipulation checks revealed that compared to the control group, state worry increased in the induction but also in the reduction group. ERN amplitudes did not vary as a function of state worry. An association of trait worry with larger ERN amplitudes was only observed in females. Furthermore, we found larger ERN amplitudes in participants with a current or lifetime diagnosis of internalizing disorders. In summary, our findings suggest that the ERN seems to be insensitive to variations in state worry, but that an elevated ERN is associated with the trait-like tendency to worry and internalizing psychopathology, which is consistent with the notion that the ERN likely represents a trait-like neural risk associated with anxiety.

Hormonal contraceptive use moderates the association between worry and error-related brain activity

Uncovering mechanisms that can help explain the experience and impact of anxiety in women is important for improving etiological models and treatments to meet the needs of unique individuals. An enlarged error-related negativity (ERN) - an electrophysiological marker of cognitive control-related error monitoring- represents one indicator of neural processes more strongly related to anxiety in women than men. In this study, we further examined this association in women by testing the moderating effect of hormonal contraceptive (HC) use on the relationship between worry - i.e., a transdiagnostic cognitive dimension of anxiety - and the ERN. Results revealed that HCs moderated the worry-ERN association. Specifically, we found a significant and large relationship between worry and enlarged ERN in women using HCs, which was smaller and nonsignificant in naturally cycling women (i.e., those not using HCs). These findings suggest that the interplay among HC use, error-related cognitive control, and worry represents a novel mechanism for better characterizing the expression and impact of worry in women.

Were we erring? The impact of worry and arousal on error-related negativity in a non-clinical sample

The monitoring of one's own actions allows humans to adjust to a changing and complex world. Previous neuroscientific research found overactive action monitoring and increased sensitivity to errors to be associated with anxiety and it is assumed to contribute to the development and maintenance of anxiety symptoms. A largely shared decomposition of anxiety differentiates two dimensions: anxious apprehension (i.e., worry) and anxious arousal (i.e., physiological hyperarousal). Alterations in neural correlates of error monitoring have been more closely linked to anxious apprehension compared to anxious arousal. This study examined the relationship between anxiety dimensions and electrophysiological correlates of action monitoring (i.e., error-related negativity, ERN, and correct-response negativity, CRN). A total of 135 non-clinical participants performed a flanker task while their electroencephalogram was recorded. We recruited participants with converging and diverging anxiety dimension profiles (i.e., above or below median in anxious apprehension and anxious arousal or above median in one and below in the other dimension). This grouping strategy facilitates disentangling possible interactions and allows the investigation of the isolated effect of each anxiety dimension. Regression analyses did not reveal a significant main or interaction effect of anxiety dimensions on ERN or CRN, irrespective of gender. In addition, Bayesian statistical analyzes yielded evidence for the absence of an association between both anxiety dimensions and ERN and CRN. Altogether, our results suggest that the association of anxiety dimensions, particularly anxious apprehension, and action monitoring might be smaller in non-clinical samples as previous studies indicate.

On Variation in Mindfulness Training: A Multimodal Study of Brief Open Monitoring Meditation on Error Monitoring

A nascent line of research aimed at elucidating the neurocognitive mechanisms of mindfulness has consistently identified a relationship between mindfulness and error monitoring. However, the exact nature of this relationship is unclear, with studies reporting divergent outcomes. The current study sought to clarify the ambiguity by addressing issues related to construct heterogeneity and technical variation in mindfulness training. Specifically, we examined the effects of a brief open monitoring (OM) meditation on neural (error-related negativity (ERN) and error positivity (Pe)) and behavioral indices of error monitoring in one of the largest novice non-meditating samples to date (N = 212). Results revealed that the OM meditation enhanced Pe amplitude relative to active controls but did not modulate the ERN or behavioral performance. Moreover, exploratory analyses yielded no relationships between trait mindfulness and the ERN or Pe across either group. Broadly, our findings suggest that technical variation in scope and object of awareness during mindfulness training may differentially modulate the ERN and Pe. Conceptual and methodological implications pertaining to the operationalization of mindfulness and its training are discussed.

Clarifying the relationship between mindfulness and executive attention: a combined behavioral and neurophysiological study

Mindfulness is frequently associated with improved attention. However, the nature of the relationship between mindfulness and executive attention, a core function of the attentional system, is surprisingly unclear. Studies employing behavioral measures of executive attention have been equivocal. Although neuroscientific studies have yielded more consistent findings, reporting functional and structural changes in executive attention brain regions, the observed changes in brain activity have not been linked to behavioral performance. The current study aimed to fill these gaps in the literature by examining the extent to which trait mindfulness related to behavioral and neurophysiological (indexed by the stimulus-locked P3) measures of executive attention. Results revealed that higher trait mindfulness was related to less flanker interference on accuracy and reaction time, consistent with enhanced executive attention. Critically, mediational analyses showed that the P3 accounted for the relationship between trait mindfulness and executive attention performance, elucidating a neural mechanism through which mindfulness enhances executive attention.

Error-related brain activity and internalizing disorder symptom dimensions in depression and anxiety

BACKGROUND

Research suggests that enhanced neural reactivity to errors, measured via the error-related negativity (ERN), is relatively unique to internalizing psychopathologies (IPs) and symptom clusters characterized by excessive worry and apprehension. However, no prior study has tested the association between the ERN and IP symptom dimensions in a heterogeneous, clinically representative patient population. The current study was designed to address this gap in the literature and clarify the role of the ERN in an adult IP treatment-seeking patient sample.

METHOD

Eighty-five participants completed a well-validated flanker task known to robustly elicit the ERN and a battery of questionnaires assessing a range of IP symptoms. All participants had at least one IP diagnosis and over 75% had co-occurring IPs. A principal components analysis (PCA) was performed on the questionnaire data indicating two distinct factors that characterized the IP sample: affective distress/misery and fear-based anxiety.

RESULTS

Analyses indicated that within this sample, an enhanced ERN, but not CRN, was associated with greater fear-based anxiety symptoms but had no relation with distress/misery symptoms.

CONCLUSIONS

Together, these findings indicate that an enhanced ERN may not be specific to worry/apprehension and may extend to the IP fear dimension. The results also converge with a broader literature suggesting that fear-based psychopathology is characterized by an exaggerated reactivity to threat and this objective, psychophysiological response tendency may distinguish fear disorders from distress.

The effect of expressive writing on the error-related negativity among individuals with chronic worry

The error-related negativity (ERN), an ERP elicited immediately after errors, is enlarged among individuals with anxiety. The relationship between anxiety and enlarged ERN has spurred interest in understanding potential therapeutic benefits of decreasing its amplitude within anxious individuals. The current study used a tailored intervention-expressive writing-in an attempt to reduce the ERN among a sample of individuals with chronic worry. Consistent with hypotheses, the ERN was reduced in the expressive writing group compared to an unrelated writing control group. Findings provide experimental support that the ERN can be reduced among anxious individuals with tailored interventions. Expressive writing may serve to "offload" worries from working memory, therefore relieving the distracting effects of worry on cognition as reflected in a decreased ERN.

The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition.

METHOD

We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP).

RESULTS

Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills.

CONCLUSIONS

Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.