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

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.

To err is human- to understand error-processing is divine: Contributions of working memory and anxiety to error-related brain and pupil responses

Both anxiety and working memory capacity appear to predict increased (more negative) error-related negativity (ERN) amplitudes, despite being inversely related to one another. Until the interactive effects of these variables on the ERN are clarified, there may be challenges posed to our ability to use the ERN as an endophenotype for anxiety, as some have suggested. The compensatory error monitoring hypothesis suggests that high trait-anxiety individuals have larger ERN amplitudes because they must employ extra, compensatory efforts to override the working memory demands of their anxiety. Yet, to our knowledge, no ERN study has employed direct manipulation of working memory demands in conjunction with direct manipulations of induced (state) anxiety. Furthermore, little is known about how these manipulations affect other measures of error processing, such as the error-related pupil dilation response and post-error behavioral adjustments. Therefore, we manipulate working memory load and anxiety in a 2 × 2 within-subjects design to examine the interactive effects of working memory load and anxiety on ERN amplitude, error-related pupil dilation response amplitude, and post-error behavior. There were no effects of our manipulations on ERN amplitude, suggesting a strong interpretation of compensatory error-processing theory. However, our worry manipulation affected post-error behavior, such that worry caused a reduction in post-error accuracy. Additionally, our working memory manipulation affected error-related PDR magnitude and the amplitude of the error-related positivity (Pe), such that increased working memory load decreased the amplitude of these responses. Implications of these results within the context of the compensatory error processing framework are discussed.

Effects of Expressive Writing on "Choking under Pressure" in High Test-Anxious Individuals

(1) Background: High test-anxious students often fail to perform at their actual level and are prone to choking under pressure (CUP). The aim of the present study was to investigate whether expressive writing (EW) can help high test-anxious individuals reduce the degree of the CUP effect, and whether the intervention effects were different in people with different working memory capacities. (2) Methods: High test-anxious participants wrote expressively (EW group) or neutrally (control group) according to guidance, and then completed a modular arithmetic (MA) task under a high-stress condition. (3) Results: The state anxiety score of the control group was significantly higher than that of the EW group in the high-pressure situation, indicating that the EW intervention was helpful to alleviate the state anxiety. Subjects with high working memory capacity in the control group performed the complex MA task significantly less accurately in the high-stress situation than in the low-stress situation, showing the CUP effect. There was no significant difference in complex MA task scores between high- and low-stress situations for subjects with high working memory capacity in the EW group, indicating that the EW intervention can reduce the degree of the CUP effect. (4) Conclusions: EW intervention was effective in reducing state anxiety levels and attenuating the detrimental effects of test stress on cognitive processing in test-anxious individuals with high working memory capacity.

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.

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.

Does expressive writing or an instructional intervention reduce the impacts of test anxiety in a college classroom?

Test anxiety is a major concern in education because it causes uncomfortable feelings in test-anxious students and may reduce the validity of exam scores as a measure of learning. As such, brief and cost-effective interventions are necessary to minimize the negative impact of test anxiety on students’ academic performance. In the present experiment, we examine two such interventions: expressive writing (Experiment 1) and an instructional intervention (Experiment 2), with the latter developed from a similar intervention for stereotype threat. Across four authentic exams in a psychology class, students alternated between completing the intervention and a control task immediately before completing the exams. Neither intervention was effective at reducing test anxiety or improving exam performance. The present results suggest that these interventions may not be successful in addressing the impacts of test anxiety in all classroom settings.

Use of cognitive event-related potentials in the management of psychiatric disorders: Towards an individual follow-up and multi-component clinical approach

Relapse prevention remains a major challenge in psychiatry, thus indicating that the established treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. In recent years, several intervention strategies have been devised that are aimed at improving psychiatric treatment by providing a complementary set of add-on tools that can be used by clinicians to improve current patient assessment. Among these, cognitive event-related potentials (ERPs) have been indexed as valuable biomarkers of the pathophysiological mechanisms of various mental illnesses. However, despite decades of research, their clinical utility is still controversial and a matter of debate. In this opinion review, I present the main arguments supporting the use of cognitive ERPs in the management of psychiatric disorders, stressing why it is currently still not the case despite the vast number of ERP studies to date. I also propose a clinically-oriented suitable way in which this technique could - in my opinion - be effectively incorporated into individual patient care by promotion of the use of individual ERP test-retest sessions and the use of a multi-component approach.

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.

Nature as a potential modulator of the error-related negativity: A registered report

According to Kaplan's Theory of Attention Restoration (ART), spending time in a natural environment can restore depleted cognitive resources. If this is true, then nature exposure may modulate the error-related negativity (ERN), a component of the event-related brain potential (ERP) that is related to cognitive control and attentional allocation. ART suggests that cognitive resources are restored because the cognitive control networks of the brain are less engaged in nature, suggesting that the ERN may decrease in nature. In the present study, we completed a registered report, examining whether or not spending time in nature would reduce the size of the ERN compared to outdoor testing. Instead, we found that nature significantly increased the amplitude of the ERN. The implications of these results are discussed within the ART framework.

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.

Moderation of the relationship between the error-related negativity and anxiety by age and gender in young children: A preliminary investigation

The error-related negativity (ERN) is a neurophysiologic response to errors that associates with anxiety. Despite the potential relevance of the ERN for understanding mechanisms of early anxiety problems in the developing brain, the relation between ERN and anxious symptoms in young children remains poorly understood. Emerging evidence suggests that ERN-anxiety associations could vary by developmental stage, but this work requires replication and consideration of gender effects, given earlier maturation of the ERN and higher rates of anxiety problems in girls relative to boys. To address this gap, the ERN was collected in 49 preschool- to school-aged children (ages 4-9; 26 girls) sampled across a wide range of anxiety severity. Regression analyses revealed that ERN - anxiety associations depended on age and gender. Specifically, larger (more negative) ERN associated with more anxiety in older girls, whereas smaller ERN associated with more anxiety symptoms in younger girls. No ERN-anxiety association was found in boys. These findings suggest that age and gender moderate the direction of the relation between ERN and anxiety in early childhood and could have important implications for the development of ERN-based risk identification and targeted treatment strategies tailored to individual children.

Reliable and efficient recording of the error-related negativity with a speeded Eriksen Flanker Task

OBJECTIVE

There is accumulating evidence that the error-related negativity (ERN), an event-related potential elicited after erroneous actions, is altered in different psychiatric disorders and may help to guide treatment options. Thus, the ERN is a promising candidate as a psychiatric biomarker. Basic methodological requirements for a biomarker are that their measurements are standardised and reliable. The aim of the present study was to establish ERN acquisition in a reliable, time-efficient and patient-friendly way for use in clinical practice.

METHODS

Healthy subjects performed a speeded Eriksen Flanker Task that increases the number of errors. In a test-retest design (N = 14) with two sessions separated by 28 days we assessed the reliability of the ERN. To ensure external validity, we aimed to replicate previously reported correlation patterns of ERN amplitude with (A) number of errors and (B) negative affect. In order to optimise the clinical use of the task, we determined to which extent the task can be shortened while keeping reliability >0.80.

RESULTS

We found excellent reliability of the ERN (intraclass correlation coefficients = 0.806-0.947) and replicated ERN correlation patterns. The task can be halved to a patient-friendly length of 200 trials (recorded in 8 min) keeping reliability >0.80.

CONCLUSIONS

The modified task provides reliable and efficient recording of the ERN, facilitating its use as a psychiatric biomarker.

Error-related brain activity in pediatric anxiety disorders remains elevated following individual therapy: a randomized clinical trial

BACKGROUND

Anxiety disorders are associated with an overactive action monitoring system as indexed by a larger error-related negativity (ERN). This study tests whether ERN magnitude changes following treatment, predicts response to treatment, and varies by treatment type.

METHODS

The sample included 130 youth (9-14 years): youth with an anxiety disorder (ANX; n = 100) and healthy control (HC; n = 30) youth with no lifetime DSM-IV disorders. ANX youth were randomized to either a manualized cognitive-behavior therapy (CBT) or a comparison child-centered therapy (CCT). The ERN was assessed before and after 16 sessions of treatment and within a comparable interval for HC. Subjective ratings about making errors on the task were obtained following each testing session. The ClinicalTrials.gov identifier is NCT00774150.

RESULTS

The ERN was larger in ANX than HC youth but ERN magnitude did not significantly change following treatment in the ANX youth, regardless of treatment type, and baseline ERN did not predict treatment response. Post-task ratings revealed that ANX youth worried more about task performance feedback than HC. Like the ERN, mean ratings did not significantly change following treatment. However, these ratings were not correlated with ERN amplitude.

CONCLUSIONS

Findings of greater ERN in pediatric anxiety disorders are replicated in a larger sample. More importantly, findings from this randomized control trial show that a larger ERN and feeling worried about performance feedback remain unchanged following treatment and are unrelated to treatment response. Such findings suggest that action monitoring systems remain overactive in anxious youth treated with psychotherapy, suggesting the need for future investigation of whether novel complimentary cognitive and emotional training programs can modify these systems would be warranted.

Associations of Observed Performance Monitoring During Preschool With Obsessive-Compulsive Disorder and Anterior Cingulate Cortex Volume Over 12 Years

IMPORTANCE

Monitoring one's performance is necessary for learning and adaptive behavior; however, heightened performance monitoring is a purported endophenotype of obsessive-compulsive disorder (OCD). The anterior cingulate cortex (ACC), a brain region implicated in the pathogenesis of OCD, is associated with performance monitoring. Whether performance monitoring early in development is an identifiable risk factor for OCD and whether early childhood performance monitoring is associated with later alterations in ACC volume are unknown.

OBJECTIVE

To determine whether an observed indicator of heightened performance monitoring during the preschool age is associated with later onset of OCD and altered dorsal ACC (dACC) volume through adolescence.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal observational cohort study was performed at an academic medical center as part of the Preschool Depression Study. A sample of 292 children oversampled for depression from September 22, 2003, through May 12, 2005, completed a performance-based observational task during which they received persistent negative evaluation. Blind raters behaviorally coded child performance monitoring. During the next 12 years, children completed annual diagnostic assessments; 133 completed the final behavioral follow-up and 152 contributed 1 to 3 magnetic resonance imaging scans. Follow-up was completed on August 14, 2017.

MAIN OUTCOMES AND MEASURES

Onset of DSM-5 diagnosis of OCD from baseline to the final behavioral assessment and whole-brain-adjusted dACC volume at the 3 waves of scanning.

RESULTS

Among the 292 preschool children who completed the baseline evaluation (51.4% boys; mean [SD] age, 4.5 [0.8] years), when controlling for demographic and clinical indicators, those who exhibited observed heightened performance monitoring were 2 times more likely to develop OCD (n = 35) during the next 12 years (odds ratio, 2.00; 95% CI, 1.06-3.78; P = .03). Multilevel modeling of dACC volume across the 3 scan waves (n = 152) demonstrated that heightened performance monitoring was associated with smaller right dACC volume (intercept estimate, -0.14; SE, 0.07; t = -2.17; P = .03).

CONCLUSIONS AND RELEVANCE

An ecologically valid indicator of performance monitoring in early childhood was associated with onset of OCD and smaller dACC volumes in later childhood and adolescence. Early childhood observed performance monitoring is a readily observed risk factor of OCD that can be identified in preschool-aged children.