The Role of Error-Related Negativity in Social Anxiety, Depression, and Treatment Outcome

Social anxiety disorder (SAD) and major depressive disorder (MDD) are common psychological disorders which remain difficult to treat, as many individuals do not benefit from cognitive behavioral therapy (CBT). Research suggests SAD may be characterized by exaggerated error-related negativity (ERN) while those with MDD may display blunted ERN, relative to healthy controls (HC). However, mixed findings, possibly due to methodological differences across studies, suggest further study is warranted. Furthermore, there is a paucity of research on the ERN as a predictor of CBT-related symptom improvement in SAD or MDD. This study leverages an ongoing clinical trial (R01 MH101497-01, Yr 4 of 5), which uses a multimethod approach to evaluate predictors and mechanisms of change in patients with SAD or MDD following CBT, which was compared to supportive therapy (ST), a psychological placebo. The study also includes a comparator HC group that does not receive treatment; however, healthy participants complete the same assessments and tasks as patients at the same time points as patients. Using a validated flanker task during electroencephalography, we examined baseline group differences in ERN and investigated whether baseline ERN predicted symptom reduction in patients. We hypothesized 1) baseline ERN amplitude would be greater in SAD relative to HC and MDD; 2) baseline ERN amplitude would be lower in MDD relative to HC and SAD; and 3) baseline ERN would predict CBT (but not ST) outcome in SAD and MDD. The same analyses were performed on the error positivity (Pe) as an exploratory aim. Results showed no group differences in baseline ERN or Pe, and ERN did not predict treatment outcome. However, patients with greater Pe showed a steeper decline in symptoms across treatments. Results suggest ERN may not adequately characterize SAD and MDD and their treatment. Rather, awareness of errors, measured via Pe, may serve as a marker of psychotherapy outcome in SAD or MDD.