Error-related brain activity in youth and young adults before and after treatment for generalized or social anxiety disorder

Abstract

Increased error monitoring, as measured by the error-related negativity (ERN), has been shown to persist after treatment for obsessive-compulsive disorder in youth and adults; however, no previous studies have examined the ERN following treatment for related anxiety disorders. We used a flanker task to elicit the ERN in 28 youth and young adults (8–26 years old) with primary diagnoses of generalized anxiety disorder (GAD) or social anxiety disorder (SAD) and 35 healthy controls. Patients were assessed before and after treatment with cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRI), and healthy controls were assessed at a comparable interval. The ERN increased across assessments in the combined sample. Patients with SAD exhibited an enhanced ERN relative to healthy controls prior to and following treatment, even when analyses were limited to SAD patients who responded to treatment. Patients with GAD did not significantly differ from healthy controls at either assessment. Results provide preliminary evidence that enhanced error monitoring persists following treatment for SAD in youth and young adults, and support conceptualizations of increased error monitoring as a trait-like vulnerability that may contribute to risk for recurrence and impaired functioning later in life. Future work is needed to further evaluate the ERN in GAD across development, including whether an enhanced ERN develops in adulthood or is most apparent when worries focus on internal sources of threat.

A Neurobehavioral Mechanism Linking Behaviorally Inhibited Temperament and Later Adolescent Social Anxiety

“…Consistent with this notion, intervention studies have shown that treatment for anxiety disorders does not influence the ERN itself. 45,46 In conclusion, future research should not only seek to replicate the mechanism described here, but also identify variables that selectively influence subcomponents of this neurobehavioral mechanism explaining the link between BI and social anxiety.…”

Impact of anxiety symptoms and problematic alcohol use on error-related brain activity

“…From this perspective, the ERN reflects not only the detection of errors but also the signaling of the salience of errors in-order to guide behavior across contexts (Olvet & Hajcak, 2008; Weinberg et al, 2016). As would be expected, numerous studies have found that individuals with current anxiety disorders, and those with high trait anxiety, display an enhanced ERN compared with healthy controls (Hajcak, McDonald, & Simons, 2003; Weinberg, Olvet, & Hajcak, 2010; Kujawa et al, 2016; Meyer, Hajcak, Glenn, Kujawa, & Klein, 2016a). An enhanced ERN is also thought to distinguish anxiety from depression.…”

“…The results also indicate that prior ERN findings are generalizable to a highly comorbid, representative, treatment-seeking patient population. Given that the ERN has been shown to be moderately heritable (Anokhin et al, 2008), stable over time (Weinberg & Hajcak, 2011), and resistant to treatment effects (Kujawa et al, 2016), it may reflect an endophenotype for anxiety psychopathology (Olvet & Hajcak, 2008) and distinguish anxiety from depression.…”

“…The ΔERN is used to isolate activity unique to error processing (Simons, 2010), and has been extensively used in prior studies investigating the ERN (Jackson, Nelson, Meyer, & Hajcak, 2017; Kujawa et al, 2016). The ΔERN was therefore considered the primary dependent variable; however, secondary models were also run using the individual ERN and CRN variables to provide additional information regarding variations in activity to errors and correct trials.…”

The development of the error-related negativity in large sample of adolescent females: Associations with anxiety symptoms

“…In light of the fact that the ERN is thought to reflect sensitivity to making mistakes, as well as evidence that normative increases in social anxiety are particularly pronounced during adolescence (La Greca Lopez, 1998; Wittchen, Stein, & Kessler, 1999) , we hypothesized that while the ERN may relate to multiple symptom scales, it would have the strongest relationship with social anxiety. This hypothesis is based on previous work finding an increased ERN in individuals with social anxiety (Endrass et al, 2014; Kujawa et al, 2016), as well as work suggesting the ERN is specifically sensitive to social contexts (Barker, Troller-Renfree, Pine, & Fox, 2015). Importantly, a previous study in adolescents found that the ERN was associated with social anxiety, but not generalized anxiety (Kujawa et al, 2016) – suggesting that the ERN may have specific relationships with social anxiety during adolescence.…”