Enhanced Performance Monitoring as a Transdiagnostic Risk Marker of the Anxiety and Obsessive-Compulsive Spectrum: The Role of Disorder Category, Clinical Status, Family Risk, and Anxiety Dimensions

In this preregistered study, we investigated the relationship between neural correlates of performance monitoring and disorders of the anxiety and obsessive-compulsive spectrum. Specifically, we aimed at understanding the role of disorder category, clinical status, family risk, and the transdiagnostic symptom dimensions of anxious apprehension and anxious arousal. To this end, we measured event-related potentials (ERPs) of performance monitoring (i.e., error-related negativity, ERN, and correct-response negativity, CRN) in a large sample of 156 participants, including groups of patients with obsessive-compulsive disorder, social anxiety disorder, and specific phobia, as well as a naturalistic control group. Contrary to our initial expectations, we did not observe significant differences in ERPs among the clinical groups, nor in comparison to the naturalistic control group. However, after creating a more strictly defined healthy control group, we found larger ERN amplitudes in the specific phobia compared with the healthy control group. In addition, when comparing participants with and without a lifetime clinical diagnosis of any internalizing disorder, regardless of their main diagnosis, as well as when comparing those with or without a family risk for internalizing psychopathology, we observed larger amplitudes for both ERN and CRN. Subsequently, we combined data from this study and a previously published subclinical study to examine the role of transdiagnostic symptom dimensions (i.e., anxious apprehension and anxious arousal) across a wider severity spectrum. In this joint sample of 246 participants, gender emerged as a moderator of the link between anxious apprehension and enhanced performance monitoring. Specifically, women with increasing anxious apprehension exhibited elevated ERN and CRN amplitudes. In conclusion, our study challenges the notion of a disorder-specific link to performance monitoring. Instead, our findings suggest that enhanced performance monitoring is associated with a higher propensity for anxious apprehension and acts as a broad risk marker for internalizing psychopathology, reflecting vulnerability beyond diagnostic borders within the anxiety- and obsessive-compulsive spectrum.

Are errors more aversive in an uncertain world? Testing the influence of uncertainty on the error-related negativity in a randomized controlled trial

Overactive error monitoring-as measured by the error-related negativity (ERN)-is a candidate transdiagnostic risk marker for internalizing psychopathology. Previous research reported associations of the ERN and individual differences in intolerance of uncertainty (IU). These findings imply associations between the subconstructs of IU (prospective and inhibitory IU) and the ERN, which we sought to replicate and extend by testing for causal influences that might elucidate specific mechanisms underlying this association. To test associations of uncertainty and the ERN, a preregistered, randomized-controlled design was employed. After measuring the baseline ERN of N = 120 university students, a subsample was randomly assigned to two groups: While an intervention group (n = 30) performed an unsolvable probabilistic "learning" task intended to induce state uncertainty, a passive control group (n = 30) rested. Subsequently, the ERN was assessed again. Self-reported uncertainty was assessed before and after the intervention. To further increase the statistical power of the replication attempt, we performed a correlation analysis (non-preregistered) by including data from two additional samples collected at different study sites. This analysis comprised psychophysiological data from a total of N = 355 participants. Cross-sectionally, no effects of IU on the ERN emerged. Regarding the state uncertainty induction, the intervention group displayed increased self-reported uncertainty after the intervention, but no evidence emerged for ERN alterations attributable to the intervention. The link between individual differences in IU and the ERN might be smaller and less robust than previous findings suggest, reflecting the understudied character of this association. The absence of evidence for mechanistic changes in the ERN due to a successful induction of state uncertainty further questions a link between IU and the ERN. In line with previous studies that linked increased ERN to anxiety, independent of current clinical status, the ERN seems unaffected by short-term changes such as symptom provocations in non-clinical populations.

How to improve reward sensitivity - Predictors of long-term effects of a randomized controlled online intervention trial

BACKGROUND

Reward sensitivity is a central maintaining factor of depression. Current treatments fail at sufficiently and reliably modifying reward processing. Therefore, we employed interventions targeting reward sensitivity and evaluated the long-term efficacy of different online interventions, additionally exploring predictors of changes in reward sensitivity.

METHODS

This four-arm randomized controlled trial (RCT) tested the long-term stability of treatment effects during a four-month follow-up in 127 participants of a two-week online intervention (behavioral activation vs. mindfulness and gratitude vs. combination of both). In addition, we investigated predictors of treatment success defined as improvement in reward sensitivity. Predictors we investigated were depressive expectations, stress and the type of reward implemented in the exercises of the intervention (physical activities and social encounters).

RESULTS

The improvement concerning reward sensitivity, as well as the reduction of anhedonia and depressive symptoms was stable over a four-month follow-up. We did not find evidence for differences between the active intervention groups. Positive changes in depressive expectations were a significant predictor of long-term improvements in reward sensitivity.

LIMITATIONS

Only self-report measures were used and the interpretation of the long-term efficacy of the online interventions is limited since the waitlist control condition was not extended to the follow-up.

CONCLUSIONS

Clinicians should focus on violating depressive expectations to facilitate updating the prediction and anticipation of future rewarding experiences. This could be a vital mechanism of change in reward sensitivity. However, future research still needs to unravel what kind of interventions are most effective in targeting reward insensitivity.

Neural underpinnings of fine motor skills under stress and anxiety: A review

This review offers a comprehensive examination of how stress and anxiety affect motor behavior, particularly focusing on fine motor skills and gait adaptability. We explore the role of several neurochemicals, including brain-derived neurotrophic factor (BDNF) and dopamine, in modulating neural plasticity and motor control under these affective states. The review highlights the importance of developing therapeutic strategies that enhance motor performance by leveraging the interactions between key neurochemicals. Additionally, we investigate the complex interplay between emotional-cognitive states and sensorimotor behaviors, showing how stress and anxiety disrupt neural integration, leading to impairments in skilled movements and negatively impacting quality of life. Synthesizing evidence from human and rodent studies, we provide a detailed understanding of the relationships among stress, anxiety, and motor behavior. Our findings reveal neurophysiological pathways, behavioral outcomes, and potential therapeutic targets, emphasizing the intricate connections between neurobiological mechanisms, environmental factors, and motor performance.

Everyday emotion, naturalistic life stress, and the prospective prediction of adolescent depression

BACKGROUND AND OBJECTIVES

Increasing research underscores low positive emotion (PE) as a vital component of depression risk in adolescence. Theory also suggests that PE contributes to adaptive coping. However, it is unclear whether naturalistic experiences of emotions contribute to long-term depression risk, or whether daily PE levels equip adolescents to cope with later naturalistic stressors, reducing risk for depression. The current study examines whether PE (and negative emotion [NE]) assessed via ecological momentary assessment (EMA) (a) predict prospective increases in depression, and (b) moderate the association between later life stressors and depression.

DESIGN

Longitudinal study of community-recruited adolescents, with EMA at baseline.

METHOD

Adolescents (n = 232) completed contextual threat life stress interviews, interview and self-report measures of depression at baseline and 1.5 year follow-up. At baseline, they completed a seven-day EMA of emotion.

RESULTS

Preregistered analyses showed that daily NE, but not PE, predicted increased depression over time and moderated the association between interpersonal episodic stress and self-reported depression.

CONCLUSIONS

Results did not support daily PE as a buffer against depressogenic effects of life stress, but point to daily NE as a marker of depression risk.

The associations among sleep-related difficulties, anxiety, and error-related brain activity in youth

Given the high prevalence of anxiety disorders and their associated impairment, elucidating neural mechanisms related to these disorders has been increasingly prioritized. The error-related negativity (ERN) has been identified as a neural marker that indexes risk for anxiety across development. The ERN seems to confer risk for developing anxiety, especially in the context of stressful life events. The present study sought to examine sleep-related difficulties as another stressful factor that might impact the ERN. In a sample of 221 girls, aged 8 to 15 years old, we first examined the relationship between longer-term (i.e., over the past month) and shorter-term (i.e., over the past week) sleep difficulties and the ERN. We then investigated whether specific sleep difficulties uniquely predict the ERN. In exploratory analyses, we assessed whether sleep difficulties moderate the relationship between the ERN and anxiety. Results indicated that youth who report longer-term lower sleep duration, longer-term worse sleep, and shorter-term lower sleep duration on school days over the past week have a larger (i.e., more negative) ERN. Additionally, only shorter-term sleep duration on school days over the past week uniquely predicted the ERN. Finally, an elevated ERN predicted greater clinical anxiety in the context of longer-term sleep difficulties. Future studies should clarify the direction of these associations via longitudinal designs.

The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi

Depressive disorders are leading contributors to morbidity in low- and middle-income countries and are particularly prevalent among people with non-communicable diseases (NCD). Stressful life events (SLEs) are risk factors for, and can help identify those at risk of, severe depressive illness requiring more aggressive treatment. Yet, research on the impact of SLEs on the trajectory of depressive symptoms among NCD patients indicated for depression treatment is lacking, especially in low resource settings. This study aims to estimate the longitudinal association of SLEs at baseline with depression remission achievement at three, six, and 12 months among adults with either hypertension or diabetes and comorbid depression identified as being eligible for depression treatment. Participants were recruited from 10 NCD clinics in Malawi from May 2019-December 2021. SLEs were measured by the Life Events Survey and depression remission was defined as achieving a Patient Health Questionaire-9 (PHQ-9) score <5 at follow-up. The study population (n = 737) consisted predominately of females aged 50 or higher with primary education and current employment. At baseline, participants reported a mean of 3.5 SLEs in the prior three months with 90% reporting ≥1 SLE. After adjustment, each additional SLE was associated with a lower probability of achieving depression remission at three months (cumulative incidence ratio (CIR) 0.94; 95% confidence interval: 0.90, 0.98, p = 0.002), six months (0.95; 0.92, 0.98, p = 0.002) and 12 months (0.96; 0.94, 0.99, p = 0.011). Re-expressed per 3-unit change, the probability of achieving depression remission at three, six, and 12 months was 0.82, 0.86, and 0.89 times lower per 3 SLEs (the median number of SLEs). Among NCD patients identified as eligible for depression treatment, recent SLEs at baseline were associated with lower probability of achieving depression remission at three, six, and 12 months. Findings suggest that interventions addressing SLEs during integrated NCD and depression care interventions (e.g., teaching and practicing SLE coping strategies) may improve success of depression treatment among adult patient populations in low-resource settings and may help identify those at risk of severe and treatment resistant depression.

Neural response to rewards moderates the within-person association between daily positive events and positive affect during a period of stress exposure

Stress and neural responses to reward can interact to predict psychopathology, but the mechanisms of this interaction are unclear. One possibility is that the strength of neural responses to reward can affect the ability to maintain positive affect during stress. In this study, 105 participants completed a monetary reward task to elicit the reward positivity (RewP), an event-related potential sensitive to rewards. Subsequently, during a stressful period, participants reported on their affect nine times a day and on daily positive and negative events for 10 days. Even during heightened stress, experiencing more positive events was associated with increased positive affect. The RewP significantly moderated this association: Individuals with a larger RewP reported greater increases in positive affect when they experienced more positive events, relative to individuals with a smaller RewP. A blunted RewP might contribute to stress susceptibility by affecting how much individuals engage in positive emotion regulation during stress.

Beyond the RewP: The reward feedback-elicited LPP and its potential associations with perceived stress and internalizing symptoms in late childhood

Internalizing problems increase substantially during late childhood and early adolescence, which are known to be associated with elevated perceived stress as children transition into adolescence. One risk factor that may moderate the stress-symptom association is reward processing. While neurophysiological research in this field has focused on the reward positivity component (RewP) elicited during reward processing, little work has examined the reward feedback-elicited late positive potential (LPP) and its association with internalizing psychopathology. The present study examined the moderating roles of the RewP and feedback-elicited LPP in the relationship between perceived stress and internalizing symptoms in late childhood. A community sample of 115 nine-to-12-year-old children (66 girls, Mean age = 11.00 years, SD = 1.16) completed an EEG version of the reward feedback paradigm, the Doors task, and completed questionnaires on perceived stress and internalizing symptoms. A principal component analysis revealed three temporo-spatial factors that were temporally and spatially analogous to the RewP, anterior LPP, and posterior LPP, respectively. As expected, an enlarged RewP was found towards the win condition compared to the loss condition. We also observed a potentiated LPP towards loss relative to win feedback, which may reflect the evaluation and reappraisal processes following unsuccessful performance (i.e., loss). We did not, however, find significant moderating effects of any ERP components on the stress-symptom association. Our study was first to isolate the feedback-elicited LPP in a reward processing paradigm in children and provide initial evidence on the modulation of the ERP component by task conditions. Future research is warranted to further explore the functional significance of the reward feedback-elicited LPP in association with perceived stress and internalizing psychopathology in youths.

Parsing patterns of reward responsiveness: Initial evidence from latent profile analysis

Variation in reward responsiveness has been linked to psychopathology. Reward responsiveness is a complex phenomenon that encompasses different temporal dimensions (i.e., reward anticipation or consumption) that can be measured using multiple appetitive stimuli. Furthermore, distinct measures, such as neural and self-report measures, reflect related but distinct aspects of reward responsiveness. To understand reward responsiveness more comprehensively and better identify deficits in reward responsiveness implicated in psychopathology, we examined ways multiple measures of reward responsiveness jointly contribute to distinct psychological problems by using latent profile analysis. Specifically, we identified three profiles of reward responsiveness among 139 female participants based on their neural responses to money, food, social acceptance, and erotic images and self-reported responsiveness to reward anticipation and consumption. Profile 1 (n = 30) exhibited blunted neural responses to social rewards and erotic images, low self-reported reward responsiveness, but average neural responses to monetary and food rewards. Profile 2 (n = 71) showed elevated neural response to monetary rewards, average neural responses to other stimuli, and average self-reported reward responsiveness. Profile 3 (n = 38) showed more variable neural responses to reward (e.g., hypersensitivity to erotic images, hyposensitivity to monetary rewards), and high self-reported reward responsiveness. These profiles were differentially associated with variables generally linked to aberrations in reward responsiveness. For example, Profile 1 was most strongly associated with anhedonic depression and social dysfunction, whereas Profile 3 was associated with risk-taking behaviors. These preliminary findings may help to elucidate ways different measures of reward responsiveness manifest within and across individuals and identify specific vulnerabilities for distinct psychological problems.

Uncertainty as a driver of the youth mental health crisis

Mental health problems in young people have been on the rise for over a decade, with that trend accelerating during the pandemic. This review proposes that the catalyst effect of the pandemic offers insights into a key driver of increases in youth depression and anxiety: greater uncertainty. Uncertainty about many aspects of everyday life, including social connections, education, job security and health, increased during the pandemic, and this coincided with increasing rates of depression and anxiety. Lab-based developmental cognitive and clinical neuroscience research on tolerance of uncertainty and adolescent mental health shows that when adolescents fail to show age-typical tolerance of uncertainty, they are at greater risk of mental health problems. Avenues for future research to understand and promote tolerance of uncertainty in adolescents are proposed.

Effects of the COVID-19 Pandemic on Neural Responses to Reward: A Quasi-experiment

BACKGROUND

The COVID-19 pandemic has been a prolonged period of stress due to social isolation, illness, death, and other major life disruptions. Neural reward sensitivity, essential for healthy functioning, may become reduced under major naturalistic stressors, though few studies have examined this. The present study sought to test whether neural responses to rewards were significantly blunted by the stress of the pandemic.

METHODS

We compared 2 groups of young adult participants, who completed a monetary reward task while an electroencephalogram was recorded, at 2 time points, 1 to 3 years apart. Our measure of reward sensitivity was the reward positivity (RewP), a neural marker enhanced to gain relative to loss feedback. The magnitude of the RewP is sensitive to stress exposure and can prospectively predict depression. The pre-pandemic group (n = 41) completed both time points before the pandemic, while the pandemic group (n = 39) completed the baseline visit before the pandemic and the follow-up visit during its second year.

RESULTS

The pandemic group reported having experienced significant stressors over the course of the pandemic. We did not observe a significant decrease in the RewP from baseline to follow-up in the pre-pandemic group. In contrast, in the pandemic group, the RewP was significantly blunted at the follow-up visit to the extent that it no longer distinguished gain from loss feedback.

CONCLUSIONS

These results suggest that prolonged naturalistic stressors can result in adaptations in neural responses to rewards. Our findings also highlight a possible mechanism linking stress to the development of depression.

Risk factors for the intergenerational transmission of depression in women and girls: Understanding neural correlates of major depressive disorder and the role of early-onset maternal depression

Deficits in neural reward processing have been implicated in the etiology of depression and have been observed in high-risk individuals. However, depression is a heterogeneous disorder, and not all depressed individuals exhibit blunted neural reward response, suggesting the need to examine more specific depression phenotypes. Early-onset depression, a well-defined phenotype, has been associated with greater intergenerational transmission of depression and appears more closely linked to neural reward processing deficits. The present study examined whether a maternal history of early-onset depression was associated with neural reward response among mothers and their daughters. Mothers with and without a history of depression, as well as their biological, adolescent daughters (N = 109 dyads), completed a monetary reward guessing task while electroencephalogram was collected. Analyses focused on the Reward Positivity (RewP), an event-related potential following reward receipt. Adjusting for current depressive symptoms, maternal early-onset depression was associated with a blunted RewP in the mothers and a numerically smaller RewP in their never-depressed, adolescent daughters. Maternal adult-onset depression was not statistically associated with a blunted RewP in mothers or daughters. Thus, a blunted RewP appears to be a trait-like vulnerability marker for depression that emerges before depression onset and relates to more specific depression phenotypes (e.g., early-onset depression). These findings have implications for early identification of individuals at risk of depression and for developing more targeted interventions.

Associations of neural error-processing with symptoms and traits in a dimensional sample recruited across the obsessive-compulsive spectrum

The error-related negativity (ERN), a neural response to errors, has been associated with several forms of psychopathology and assumed to represent a neural risk marker for obsessive-compulsive disorder (OCD) and anxiety disorders. Yet, it is still unknown which specific symptoms or traits best explain ERN variation. This study investigated performance-monitoring in participants (N = 100) recruited across a spectrum of obsessive-compulsive characteristics (n = 26 patients with OCD; n = 74 healthy participants including n = 24 with low, n = 24 with medium, and n = 26 with high OC-characteristics). Several compulsivity- and anxiety-associated characteristics were assessed and submitted to exploratory principal axis factor analysis. Associations of raw measures and derived factors with ERN and correct-related negativity (CRN) were examined. Patients with OCD showed increased ERN amplitudes compared to healthy participants. The ERN was associated with a variety of traits related to anxiety and negative affect. Factor analysis results revealed a most prominent association of the ERN with a composite measure of anxiety and neuroticism, whereas the CRN was specifically associated with compulsivity. Results support differential associations for the ERN and CRN and demonstrate that a dimensional recruitment approach and use of composite measures can improve our understanding of characteristics underlying variation in neural performance monitoring.

Blunted reward responsiveness prospectively predicts emotional distress when exposed to a naturalistic stressor

Both stress and blunted reward responsiveness have been identified as core risk factors of depression. Whether blunted reward responsiveness increases psychological vulnerability to real-life stress from a dynamic perspective (from stress reactivity to recovery) has not been investigated. By utilizing a real-world stressful event (i.e. the final examination), this study aimed to explore the role of reward responsiveness in the stress-emotional distress relationship during stress reactivity and recovery phases. We followed 57 undergraduates with three assessments, from six weeks before examination weeks (T1, baseline), one day before the examinations (T2) to two weeks after the examinations (T3), therefore, covering stress reactivity (T1 to T2) and recovery (T2 to T3) phases. At baseline, reward responsiveness was measured as the Reward Positivity (RewP) in the doors task. Stress and emotional distress (anxiety and depression) were reported at T1, T2 and T3 to capture their dynamic changes. Results showed that self-report stress levels significantly increased from T1 to T2 (stress reactivity phase) and decreased from T2 to T3 (stress recovery phase). Furthermore, blunted reward responsiveness at baseline prospectively predicted emotional distress during the stress reactivity phase but not the recovery phase. Specifically, during the stress reactivity phase, higher perceived stress was associated with greater anxiety and depression only in participants with relatively smaller residual RewP amplitudes but not in participants with relatively larger residual RewP amplitudes. Our study demonstrated that a blunted reward responsiveness is a vulnerable factor of depression, especially when exposed to stress. Our findings provide insights into prevention and intervention for stress-related disturbance.

Using expectation violation models to improve the outcome of psychological treatments

Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.

Pathways to depression: Dynamic associations between neural responses to appetitive cues in the environment, stress, and the development of illness

This review focuses on research my colleagues and I have conducted on etiological pathways to depression. Much of this work has focused on the measurement of neural responses to appetitive cues, using two event-related brain potential (ERP) components, the Late Positive Potential (LPP) and the Reward Positivity (RewP). Reductions in each of these components have been associated with current symptoms of depression, and in some cases have been shown to differentiate anxious from depressive phenotypes. In this review, I will describe three broad and related approaches we have taken in our research to address a series of interdependent issuess. The first attempts to understand different sources of variation in the LPP and RewP, and how these sources interact with one another. The second tries to identify whether variation in the processes measured by these ERP components might reflect a latent vulnerability to depression and its symptoms, that is evident prior to illness onset. And the third examines the possibility that the processes reflected in the LPP and RewP might play a mechanistic role in the development of depression.