Don't worry, it won't be fine. Contributions of worry and anxious arousal to startle responses and event-related potentials in threat anticipation.

A widely shared framework suggests that anxiety maps onto two dimensions: anxious apprehension and anxious arousal. Previous research linked individual differences in these dimensions to differential neural response patterns in neuropsychological, imaging, and physiological studies. Differential effects of the anxiety dimensions might contribute to inconsistencies in prior studies that examined neural processes underlying anxiety, such as hypersensitivity to unpredictable threat. We investigated the association between trait worry (as a key component of anxious apprehension), anxious arousal, and the neural processing of anticipated threat. From a large online community sample (N = 1,603), we invited 136 participants with converging and diverging worry and anxious arousal profiles into the laboratory. Participants underwent the NPU-threat test with alternating phases of unpredictable threat, predictable threat, and safety, while physiological responses (startle reflex and startle probe locked event-related potential components N1 and P3) were recorded. Worry was associated with increased startle responses to unpredictable threat and increased attentional allocation (P3) to startle probes in predictable threat anticipation. Anxious arousal was associated with increased startle and N1 in unpredictable threat anticipation. These results suggest that trait variations in the anxiety dimensions shape the dynamics of neural processing of threat. Specifically, trait worry seems to simultaneously increase automatic defensive preparation during unpredictable threat and increase attentional responding to threat-irrelevant stimuli during predictable threat anticipation. The current study highlights the utility of anxiety dimensions to understand how physiological responses during threat anticipation are altered in anxiety and supports that worry is associated with hypersensitivity to unpredictable, aversive contexts.

A rare scare: The role of intolerance of uncertainty in startle responses and event-related potentials in anticipation of unpredictable threat.

Intolerance of uncertainty (IU) represents a transdiagnostic risk factor for internalizing psychopathology. However, little is known regarding its psychophysiological correlates. IU is thought to render individuals hypersensitive to threatening events, even if the occurrence probability is low. To test this, we recruited 90 students who completed two NPU-threat tests separating temporal unpredictability from probabilistic unpredictability (i.e., probability of occurrence): First, a NPU version in which the timing of threat (i.e., shock) was either predictable or unpredictable but the shock probability was 100 % in each trial. Second, a probabilistic NPU version in which the timing of the shock was also either predictable or unpredictable, but the shock probability was 33 % in each trial. Startle reflex, event-related potentials N1 and P3 locked to auditory startle probes, and anxiety ratings were analyzed. As expected, temporally unpredictable threat modulated startle, N1, and anxiety ratings. IU predicted increased startle to lower shock probability, regardless of the temporal predictability. No evidence emerged for IU affecting N1 or P3. However, IU predicted anxiety ratings to threat conditions regardless of temporal or probabilistic predictability. Individual differences in IU shape startle responses to eventual threat: IU increases automatic defensive responding to unpredictable and potentially threatening situations if the threat probability is low. Individuals with higher IU may tend to "err on the side of caution" with a mismatch between physiological preparation and threat probability, such that the effects of IU are particularly observable in low threat probability conditions.

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.

Early hypervigilance and later avoidance: Event-related potentials track the processing of threatening stimuli in anxiety.

Avoidance behavior is a core symptom of anxiety disorders that may hinder adaptation. Anxiety disorders are heterogeneous and previous research suggests to decompose anxiety into two dimensions: anxious apprehension and anxious arousal. How these two dimensions are associated with avoidance of and exposure to threatening stimuli, as well as their accompanying neural processes, is barely understood. We examined threat processing using event-related potentials (N1, LPP) from 134 individuals considering the influence of anxiety dimensions. During a two-phase picture-viewing task the participants watched neutral and threatening pictures, which they were instructed to either avoid or attend to during repeated presentations. Results showed that threatening compared to neutral pictures were associated with increased attention allocation (N1) and in-depth processing (LPP), modulated by task-instructions (lower during avoidance). Further, increased anxious apprehension was associated with heightened automatic attention (increased N1), followed by reduced LPP amplitudes for threatening pictures suggesting reduced in-depth processing. During re-exposure, threatening pictures were associated with increased in-depth processing, with no difference between previously avoided and maintained pictures. Together, these results illustrate that avoidance and high anxious apprehension seem to lead to similar neural changes in the processing of aversive images that may conflict with long-term adaptation.

When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic.

The outbreak of the COVID-19 pandemic has particularly affected people with obsessive-compulsive disorder (OCD). Exacerbation of obsessive-compulsive symptoms (OCS) has been suspected for those with contamination-related OCD (C-OCD). However, the course of OCS over the ongoing pandemic remains unclear. We assessed 268 participants with OCD (n = 184 with C-OCD) in an online survey at the beginning of the pandemic in Germany, reassessing 179 participants (66.8%, 104 C-OCD) three months later. We assessed severity of OCD (OCI-R), depression (PHQ-9), experiential avoidance, as well as functional and dysfunctional beliefs. Overall, OCS and depressive symptoms did not substantially change over time. However, when people with and without C-OCD were compared, symptoms improved in patients without C-OCD (nC-OCD) but remained stable in patients with C-OCD over time. Symptom improvement was associated with male gender, higher initial OCI-R, and nC-OCD. Experiential avoidance and beliefs at the beginning of the pandemic did not generally predict change in OCS. People with OCD, particularly those with nC-OCD, showed tentative signs for signs of adapting, whereas distress in those with C-OCD remained at a high level, underlining the burden for these patients. Clinicians should be informed about how to maintain effective treatment for C-OCD during a pandemic.

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.