Psychiatry Research: Neuroimaging 324 (2022) 111507

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Psychiatry Research: Neuroimaging

journal homepage: www.elsevier.com/locate/psychresns

The role of attentional shifting in the relation between error monitoring and
anxiety in youth
Michelle L. Ramos a, *, Michele Bechor a, Alejandro Casas a, Jeremy W. Pettit a,
Wendy K. Silverman b, Bethany C. Reeb-Sutherland a
a
Department of Psychology, Florida International University, Miami, FL, 33199, USA
b
Yale Child Study Center, Yale University, New Haven, CT 06520, USA

A R T I C L E I N F O A B S T R A C T

Keywords: The error-related negativity (ERN), a well-established neural marker of anxiety, reflects enhanced attention to
ERN internal threat signals. While attention to threat plays a crucial role in the development and maintenance of
Anxiety anxiety, it is unclear how attentional control influences the ERN-anxiety association. To address this, 37 youths
Attention
(Mage = 10.89 years) completed self-report measures of attentional control and anxiety symptoms. To obtain ERN
EEG
amplitude, youth completed a flanker task while simultaneous EEG was collected. Attentional control, specif­
ERP
Children ically attentional shifting rather than focusing, moderated the relation between ERN amplitude and anxiety.
Adolescents Youth who displayed smaller neural responses to making an error and higher ability to shift attention experi­
enced lower levels of anxiety, relative to those who exhibited larger neural responses to making an error or lower
attention-shifting ability. These findings highlight that response magnitude to internal threat and ability to
flexibly shift attention may jointly contribute to anxiety in youth.

1. Introduction errors is likely to be affected by attentional control.

Anxiety disorders affect nearly 20% of children and adolescents (van

1.1. Error monitoring
Schalkwyk & Silverman, 2018). There is growing interest in under­
standing the roles of attentional processes in the development and
Threats tend to be thought of as external events that can cause us
maintenance of anxiety. In this study, we examine the interplay between
harm. However, threats are not limited to the external world, and there
two attention processes, error monitoring and attentional control, in
is behavioral evidence to suggest that internal threats such as those
relation to anxiety in children and adolescents.
experienced by the production of erroneous responses can be an
Anxiety has been shown to negatively affect both attentional control,
extremely aversive variant of response conflict (Botvinick et al., 2001).
the ability to voluntarily and strategically focus and shift attention in a
Making errors leads to subjective distress and physiological changes,
goal-directed manner (Derryberry and Reed, 2002), and error moni­
such as increased heart rate, dilation of the pupils, as well as skin
toring, the detection of and adjustment for inappropriate responses
conductance changes (Proudfit et al., 2013).
(Crone et al., 2008). Specifically, individuals with anxiety show dysre­
A well-established neural marker of error monitoring is the error-
gulated attentional patterns, demonstrating an attentional bias to threat
related negativity (ERN; Hajcak et al., 2003). The ERN is an
(Cisler and Koster, 2010). This dysregulation seems to inhibit the ability
event-related potential (ERP) characterized by a fronto-central negative
to remain focused on current task demands and shift attention in the
deflection expressed within 100 ms of the commission of an error (Fal­
presence of salient but task-irrelevant stimuli (i.e., threat; Mogg and
kenstein et al., 1991; Gehring et al., 1993; Hajcak, 2012; Riesel et al.,
Bradley, 2016). Those with anxiety report increased apprehension about
2012). The ERN is said to be reflective of a monitoring system which
the commission of their mistakes, and exhibit enhanced ERN amplitudes
detects for sources of threat, such as conflicts within the environment
in response to errors, suggesting a hypervigilance to internal threat.
and making mistakes (Kujawa et al., 2016; Wauthia and Rossignol,
Therefore, this anxiety-related hypervigilance to the production of
2016), and thought to provide a signal to other brain regions so that

* Corresponding author at: Deuxieme Maison, room 200A, 11200 SW 8th St, Miami, FL 33199, USA.
E-mail address: [email protected] (M.L. Ramos).

https://doi.org/10.1016/j.pscychresns.2022.111507
Received 13 October 2020; Received in revised form 16 May 2022; Accepted 29 May 2022
Available online 2 June 2022
0925-4927/© 2022 Elsevier B.V. All rights reserved.
M.L. Ramos et al. Psychiatry Research: Neuroimaging 324 (2022) 111507

top-down control can be adjusted in anticipation of future conflicts. Both difficulties focusing attention when anxiety is high may be attributed to
youth and adults with anxiety disorders exhibit enhanced response vigilant monitoring for threatening cues in the environment. Specif­
monitoring, expressed as increased (i.e., more negative) ERN amplitudes ically, youth with clinical or self-reported high-trait anxiety exhibit a
compared to controls (for a review, see Meyer et al., 2017), suggesting a bias toward threatening stimuli within their environment (Bar-Haim
hypervigilance to internal threat (Weinberg et al., 2010). Additionally, et al., 2007; Dudeney et al., 2015), suggesting that anxiety impedes
more negative ERN amplitudes precede the onset of anxiety disorders attentional focusing on tasks with concurrent demands, particularly
within the pediatric population, such that increased ERN amplitudes at when threat is present. Previous research has also demonstrated that
six years of age was predictive of anxiety disorders at nine years of age anxiety can increase attentional focus to salient, threat-related cues
(Meyer et al., 2015). Previous work has shown that the ERN can be indicated by decreased reaction times to probes replacing salient,
elicited in young children with and without an anxiety disorder (Barker threatening cues compared to neutral cues (Eldar et al., 2010; Mueller
et al., 2015; Meyer et al., 2015; Proudfit et al., 2013; Speed et al., 2017), et al., 2009). Findings like this provide further evidence for disrupted
and has suggested that the network involved in the error monitoring top-down attentional focusing by bottom-up attentional processes
system is relatively stable throughout adolescence and adulthood in within anxiety.
typically developing individuals (Buzzell et al., 2017). This can be
crucial when considering the ERN as a potential biomarker for anxiety or 1.5. Attentional shifting
other psychopathologies as many of these disorders are characterized by
either a reduction in or enhanced ERN amplitude (Buzzell et al., 2017; Another facet of attentional control, attention shifting, has been
Olvet and Hajcak, 2008). However, little is known about how individual suggested to impact anxiety levels (Lonigan and Vasey, 2009). Attention
differences in error monitoring and attentional control ability may in­ shifting involves the adaptive allocation of attention away from
fluence anxiety. threatening cues in the environment, both internal and external, and the
redirection to information in efforts to realign with goal-directed be­
1.2. Attentional control and error monitoring haviors (Derryberry and Reed, 2002; Perez-Edgar and Fox, 2005).
Research has shown that those with higher anxiety may have a harder
While several studies have established the role of attentional control time shifting their attention away, or disengaging from threat. This is
on threat in individuals with anxiety, these studies have primarily seen in work using the dot probe task, during which, when compared to
focused on external rather than internal threat. Anxiety-related hyper­ non-anxious individuals, those with high trait-anxiety exhibit slower
vigilance to internal threats as measured by the ERN is likely also to be reaction times on trials where the probe replaces the neutral cue, sug­
influenced by attentional control. It may be that when top-down gesting that anxious individuals may be slow to shift attention away
cognitive control processes are impaired, the ability to restrain from the threat-related cue (Bar-Haim et al., 2005). There is also evi­
bottom-up attention is reduced thus producing larger responses to these dence to suggest that training clinically anxious individuals to disen­
internal threats, leading to heightened levels of anxiety. In contrast, gage, or shift away, from threat reduced both self-reported levels and
being able to adaptively deploy top-down attentional control may allow behavioral indices of anxiety during a speech task (Heeren et al., 2011).
youth to strategically shift attention away from internal threats to Additionally, increased ability to shift attention has been shown to serve
modulate levels of anxiety. as a protective factor against heightened risk for anxiety symptomology
(White et al., 2011). Findings such as these suggest attention shifting in
1.3. Attentional control theory and anxiety the maintenance and treatment of anxiety. To examine the possibility
that the ability to adaptively deploy top-down attentional control may
Attentional control theory has been used to explain the role of allow youth to strategically shift attention away from internal threats to
attentional control processes in the development and maintenance of modulate levels of anxiety, the current study aims to examine atten­
anxiety disorders (Eysenck et al., 2007). The central hypothesis of this tional control as a moderator of the ERN-Anxiety relation. This study is
theory is that anxiety impedes attentional control by selectively direct­ the first to examine whether youth self-reported attentional control,
ing attentional resources to threat-related stimuli (Eysenck et al., 2007; including shifting and focusing ability, moderates the relation between
Eysenck and Derakshan, 2011). This theory highlights two attentional ERN amplitudes and anxiety symptoms. We predicted that attentional
systems which may contribute to the dysregulation of attentional pro­ control, and more specifically shifting ability, would moderate the
cesses associated with anxiety: bottom-up or stimulus-driven attention relation between internal threat signals and anxiety level, such that
and top-down or goal-driven attention (Coombes et al., 2009). lower error monitoring and higher levels of shifting would be associated
Bottom-up or stimulus-driven attention refers to those instances during with lower levels of anxiety.
which certain, more salient aspects of a stimulus capture attention
(Theeuwes, 1991) and are attended to despite intention (Posner et al., 2. Method
1990). In contrast, top-down or goal-driven processes of attention,
including attentional control, are those which are under the control of 2.1. Participants
the individual (Asplund et al., 2010). It is proposed that anxiety disrupts
the efficiency of this goal-driven system, allowing increased influence of Twenty youths with anxiety disorders (ANX; 9 female, M = 11.4
the stimulus-driven attentional system (Eysenck et al., 2007). It is years, 8–16 years) were recruited from a clinic specializing in anxiety
further proposed that attentional control can be divided into two com­ treatment. Youth met criteria for a primary Diagnostic and Statistical
ponents: attentional focusing and attentional shifting. Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR;
American Psychiatric Association, 2000) anxiety disorder: Generalized
1.4. Attention focusing Anxiety Disorder (n = 9), Social Phobia/Anxiety Disorder (n = 5),
Separation Anxiety Disorder (n = 3), Specific Phobia (n = 2), and Panic
Attentional focus can be defined as the ability to maintain attention Disorder (n = 1). Four youth met criteria for a comorbid (non-primary)
on task-relevant stimuli, filtering out distracter information (Susa et al., diagnosis of Attention-Deficit Hyperactivity-Inattentive (ADHD-I). Four
2012). The attentional control theory suggests that anxiety can be youth were on a stable dose of medication for attention deficits (n = 1)
partially attributed to disturbances in the balance of attentional systems, or anxiety (n = 3). To increase variability in anxiety symptomology, 22
such that bottom-up processes overwhelm top-down processes particu­ healthy youth (CON) who did not meet criteria for and had never been
larly when there is a perceived presence of threat (Derakshan and diagnosed with or treated for neuropsychological, emotional, or
Eysenck, 2009; Eysenck et al., 2007; Eysenck and Calvo, 1992). That is, behavioral disorders were included. Five CON were excluded due to

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M.L. Ramos et al. Psychiatry Research: Neuroimaging 324 (2022) 111507

excessive motor artifact (n = 2), equipment malfunction (n = 1), 25,000 using AsaLab high-input impedance amplifier (Advanced Neuro
incomplete questionnaire data (n = 1), and identification as a statistical Technology, Enschede, Netherlands). Impedances were <50 kΩ and raw
outlier (n = 1) resulting in 17 CON (5 female, M = 10.65 years, 8–14 data was sampled at 1024 Hz using a high-pass filter of 0.3 Hz, and
years). referenced to CPz. Using EEGLab (Delorme and Scott Makeig, 2004),
data were resampled offline at 512 Hz, and filtered with a low-pass filter
2.2. Measures of 30 Hz. EEG was segmented into response-locked epochs -400 ms to
800 ms using ERPLab (Lopez-Calderon and Luck, 2014). The -300 to
2.2.1. Anxiety symptomology -100 ms time window was used for baseline correction. Epochs with
The Child (C) and Parent (P) versions of the Screen for Child Anxiety voltage threshold artifact of ±75 µV or observed to be noisy via visual
Related Disorders (SCARED;Birmaher et al., 1997) were administered to inspection were rejected and excluded from further analysis, and then
measure anxiety levels using 41-items scored on a three-point Likert re-referenced to average of all electrodes. The ERN and CRN were
scale. Example items include, “I worry about being as good as other kids” quantified using mean amplitude measures during response-locked error
and “My child worries that something bad might happen to his/her and correct trials, respectively, during the flanker task. In line with
parents”. Higher scores are indicative of higher levels of anxiety. The methods from previous research in a pediatric population (Hajcak et al.,
SCARED-C and SCARED-P yielded high internal consistency (α = 0.96 2007), in the current study we calculated mean amplitudes for both the
and α = 0.91, respectively). A total Anxiety Score for each participant was ERN and CRN for the time interval between -50 and 75 ms after re­
computed by averaging SCARED-P and SCARED-C total scores (Bechor sponses at Fz. Fig. 1 and S1 display the scalp topographies representing
et al., 2019; Roy et al., 2014). error- and correct-related activity -50 to 75 ms post-response on error
and correct trials, respectively, during the flanker task in youth. A dif­
2.2.2. Attentional control ference score (error minus correct; ΔERN) was also calculated for the
The Attentional Control Scale for Children (ACS-C; Muris et al., analyses.
2004) was administered as a measure of attentional control. This
20-item self-report measure contains two subscales which assess atten­ 2.4. Statistical analysis plan
tional focusing and attentional shifting on a four-point Likert scale
(Melendez et al., 2017; Muris et al., 2004; van Son et al., 2021). The To test our hypotheses, hierarchical linear regression analyses were
focus subscale measures one’s ability to maintain attention on a stim­ conducted. Age, gender, presence of ADHD, and use of medication at the
ulus, while the shift subscale assesses ability to shift attention from one time of collection were entered as covariates in all analyses. The number
stimulus to another (Melendez et al., 2017). Questions such as, “It’s very of error trials were also included as a covariate as the number of error
hard for me to concentrate on a difficult lesson, if there is a lot of noise in trials can significantly influence ERN amplitudes (Fischer et al., 2017;
the class” assess focus, while questions such as, “When I am day­ Lahat et al., 2014). Analyses were conducted on the total Anxiety Score,
dreaming or having distracting thoughts, it is easy for me to switch back and the interaction terms were computed using standardized scores (z
to the work I have to do” assess shifting. Higher scores are indicative of scores) on the respective attention measures, as well as ERP mean am­
better attentional control. Cronbach’s alpha for the total scale was 0.85 plitudes. On average, youth committed ~45 errors (range: 9–114), thus
(focusing and shifting subscales: α = 0.71 and α = 0.74, respectively). reaching the minimum of 6 error trials needed to elicit a reliable ERN
response (Meyer et al., 2013; Olvet and Hajcak, 2009). To further
2.2.3. Error monitoring explore significant interaction effects, graphical displays were created
Error monitoring was assessed using an arrow version of the flanker based on the convention for plotting interactions (see www.jeremydaws
task (Eriksen and Eriksen, 1974). Stimuli were presented using E-prime on.co.uk/slopes.htm). As the ERN is a negative going waveform, in
software (Psychology Software Tools, Pittsburgh, PA) on a 14-inch figures plotting significant interactions “Large ERN” refers to a more
laptop monitor. Youth were instructed to attend to the central arrow negative ERN amplitude response, while “Small ERN” refers to a more
and indicate its direction via mouse button press using their dominant positive ERN amplitude response. Post-hoc power analysis indicated
hand while ignoring the flanking arrows during equal numbers of that the power to detect obtained effects at the 0.05 level was 0.98 for
congruent (>>>>> or <<<<<) and incongruent (<<><< or the overall regression in the prediction of anxiety. Power to detect ob­
>><>>) trials (12 blocks, 32 trials/block, 384 trials total). Each 200 ms tained effects at the 0.05 level when examining for effects of attentional
trial was preceded by a 300–600 ms fixation cross and followed by a shifting and attentional focusing on the ERN/anxiety relation was 0.99
1700 ms response window. Inter-trial intervals adapted based upon and 0.97, respectively (G*Power 3.1.9.2; Faul, Erdfelder, Buchner, &
participant speed. Responses during the flanker task were used to Lang, 2009). As the focus of the current study was to examine individual
calculate mean RTs on both correct and error trials as well as overall rather than group differences, the data presented are continuous.
accuracy. In addition, post-error slowing was assessed by computing the Comparisons between youth with anxiety and control youth can be
difference between RTs on correct trials following incorrect responses found in Supplementary Results.
and RTs on correct trials following correct responses. Scores greater than
0 indicate the occurrence of post-error slowing. Post-error slowing is a 3. Results
well-established index of behavioral adjustment (Ladouceur et al., 2007;
Rabbitt, 1966) which is observed as a response slowing after the com­ Table 1 displays descriptive statistics and correlations between
mission of an error. These behavioral adjustments reflect top-down anxiety, attentional control scores, and ERN amplitude controlling for
cognitive control processes which aim to increase the chance of age, gender, medication usage, and presence of ADHD across the whole
responding correctly in the future (Olvet and Hajcak, 2008). See Sup­ sample, and table S1 displays the correlations, and means and standard
plemental Results for results regarding post-error slowing. deviations at the group level. A higher Anxiety Score was significantly
related to lower levels of attentional control (p = .03). Furthermore,
2.3. EEG procedures Anxiety Score was significantly and negatively correlated with focus (p
= .02), but not shifting (p = .08). No significant correlations were found
Participants were fitted with a 64-channel electrode Waveguard cap between ERN, CRN, and ΔERN amplitudes and anxiety or attentional
(ANT Neuro Corporation, Netherlands), ensuring that Cz was as cen­ control. Fig. 1 displays the response-locked grand-averaged waveforms
trally located as possible by measuring the cross-section between the displaying the error-related negativity (ERN) during error trials at Fz
two preauricular points, and the nasion and inion, and continuous EEG (solid black line) as well as correct-related negativity during correct
was recorded during the flanker task. The raw signal was amplified by trials at Fz (dashed black line).

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M.L. Ramos et al. Psychiatry Research: Neuroimaging 324 (2022) 111507

Fig. 1. Response-locked grand-averaged waveforms displaying the error-related negativity (ERN) during error trials at Fz (solid black line) as well as correct-related
negativity during correct trials at Fz (dashed black line).

Fig. 2. Scalp topographies representing error- and correct-related activity -50 to 75 ms post-response on error and correct trials, respectively, during the flanker task
in youth.

Table 1
Partial correlations between anxiety, attentional control, and ERN amplitudes controlling for age, gender, presence of ADHD, and medication use, as well as means and
standard deviations for attentional control, and ERN amplitudes.
Anxiety Score ACS-C Total ACS-C Focus ACS-C Shift ERN (µV) CRN (µV) ΔERN (µV)

ACS-C Total -.37*

ACS-C Focus -.40* .94**
ACS-C Shift -.31† .96** .79**
ERN (µV) -.14 -0.22 -.21 -.20
CRN (µV) .25 .13 .03 .19 .36*
ΔERN (µV) -.02 -.25 -0.23 -.23 .98** .36*
Mean (SD) 19.50 (11.80) 54.54 (9.87) 24.86 (4.60) 29.68 (5.75) -2.00 (5.52) 0.86 (4.87) -1.60 (5.42)

ACS-C = Attentional Control Scale for Children; ERN = error-related negativity; CRN = correct-related negativity; µV ¼ microvolts; SD = standard deviation.
*
p < .05.
**
p < .001.
†
p < .10.

Anxiety Score was regressed on continuous measures of ERN whereas youth with lower attentional control had relatively high anxiety
amplitude and total ACS-C score and the two-way interaction between regardless of the size of the ERN. Youth with high attentional control
ACS-C scores and ERN amplitude. A significant main effect was seen for and small (less negative) ERN amplitudes had the lowest anxiety levels.
ACS-C score on Anxiety Score, β = -0.357, b = -4.21, p = .03, 95% CI To gain insight into components of attentional control that may
[-8.09, -0.34], R2 = 0.36, ΔR2 = 0.11, however, no main effect was seen explain this interaction effect, the ACS-C subscales were examined
for ERN amplitudes on Anxiety Score, β = -0.23, b = -2.65, p = .18, 95% separately. Because of the strong association between shifting and
CI [-6.59, 1.28], R2 = 0.40, ΔR2 = 0.04. A significant interaction effect focusing abilities, in order to assess how each independently affects the
between ERN amplitude and ACS-C on Anxiety Score, β = -0.30, b = relation between the ERN and anxiety, shifting was included as a co­
-4.29, p = .05, 95% CI [-8.60, 0.03], R2 = 0.47, ΔR2 = 0.078, was found variate when the moderating effect of focusing was examined, and
(Fig. 3). Specifically, the standardized slope for the effect of ERN was focusing was included as a covariate when the moderating effect of
significant (p = .02) when ACS-C scores were one standard deviation shifting was examined. While there were no significant main effects of
(SD) above the mean (β = -1.22) but not one SD below the mean (β = either shifting ability, β = 0.07, b = 0.82, p > .80, 95% CI [-5.54, 7.18],
0.33, p = .53). Youth with higher attentional control showed a stronger R2 = 0.38, ΔR2 = 0.00 or ERN, β = -0.23, b = -2.72, p = .17, 95% CI
association between higher anxiety and a larger (more negative) ERN, [-6.63, 1.20], R2 = 0.42, ΔR2 = 0.041 on Anxiety Score, the interaction

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M.L. Ramos et al. Psychiatry Research: Neuroimaging 324 (2022) 111507

Fig. 3. Individual differences in self-reported attentional control moderates the relation between ERN mean amplitude and reported levels of anxiety. Note. Large
ERN = more negative ERN response; Small ERN = more positive ERN response.

between ERN amplitudes and shifting ability significantly predicted Attentional control interacted with ERN amplitudes to predict anxiety
anxiety levels independent of focus ability, β = -0.37, b = -4.69, p = .02, levels, such that youth who displayed attenuated (less negative) ERN
95% CI [-8.57, -0.81], R2 = 0.53, ΔR2 = 0.12 (Fig. 4a). The standardized amplitudes and high levels of attentional control exhibited lower levels
slope for the effect of ERN was significant (p = .01) when ACS-C shifting of anxiety compared to youth with low levels of attentional control or
scores were one SD above the mean (β = -1.33) but not one SD below the enhanced (more negative) ERN amplitudes. When shifting and focusing
mean (β = 0.37, p = .44). Youth with higher attentional shifting showed abilities were examined separately, we found that shifting abilities,
a stronger association between higher anxiety and a larger, more rather than focus abilities, moderated the relation between ERN am­
negative ERN, whereas youth with lower attentional control had rela­ plitudes and anxiety levels. These results fit within cognitive models of
tively high anxiety regardless of the size of the ERN. Youth with high anxiety that suggest that the inability to flexibly shift attention away
shifting abilities and a smaller, less negative ERN response had lower from threat-related cues contributes to the maintenance of anxiety
anxiety levels compared to youth with low shifting abilities or larger, (Barry et al., 2015; Legerstee et al., 2010), highlighting the interplay
more negative ERN. between cognitive control processes and error monitoring. Our findings
When examining focusing ability, no main effects were observed for extend these cognitive models to a measure of internal threat, the ERN,
focusing, β = -0.48, b = -5.59, p = .07, 95% CI [-11.75, 0.57], R2 = 0.42, by demonstrating that attention shifting abilities moderate the
ΔR2 = 0.07, or ERN response, β = -0.20, b = -2.40, p = .24, 95% CI ERN-anxiety relation.
[-6.45, 1.66], R2 = 0.35, ΔR2 = 0.03. Additionally, no interaction effect Individuals with clinical or self-reported high trait-anxiety exhibit a
was seen for focusing abilities, β = -0.23, b = -3.56, p = .14, 95% CI hypervigilance to threat-related stimuli compared to non-anxious in­
[-8.32, 1.21], R2 = 0.47, ΔR2 = 0.05 (Fig. 4b). No significant main ef­ dividuals (Bar-Haim et al., 2007; Bechor et al., 2019; Fox et al., 2002;
fects or interactions were found using the ΔERN, ps > 0.05. Mathews and MacLeod, 2002). This hypervigilance toward threat is
proposed to be the result of dysregulated patterns of attentional control,
4. Discussion such that bottom-up threat processes overwhelm top-down, goal-­
directed attentional processes (Derakshan and Eysenck, 2009; Derry­
The current study is the first to examine whether attentional control berry and Reed, 2002). Previous research has demonstrated a link
moderates the relation between error monitoring and anxiety in youth. between attentional bias to threat and attentional control, specifically

Fig. 4. Individual differences in self-reported (a) shifting abilities moderates the relation between ERN amplitude and reported levels of anxiety but not focusing
ability (b). Note. Large ERN = more negative ERN response; Small ERN = more positive ERN response.

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M.L. Ramos et al. Psychiatry Research: Neuroimaging 324 (2022) 111507

attentional shifting not focusing, such that youth at risk of anxiety dis­ youth age (Meyer et al., 2012), we included age as a covariate in sta­
order with impaired shifting ability displayed higher threat bias scores tistical analyses. While power analysis indicated high power, the sample
during a dot-probe task (Susa et al., 2012). Therefore, better control of size of the current study was relatively small. Further, the current study
one’s attention, such as being able to adaptively deploy top-down was unable to determine if associations between measured variables
attentional control and shifting attention, may serve to influence the differed across the primary anxiety diagnoses represented in our sample.
severity of anxiety symptomology (Melendez et al., 2017). A separate Despite these limitations, the current study shows that attentional con­
line of research documents that anxiety is associated with an enhanced trol, specifically shifting ability, moderates the relation between error
response-monitoring, specifically, a hypervigilance for error-monitoring monitoring and anxiety. Understanding the role that shifting ability may
(Buzzell et al., 2017; Torpey et al., 2013; Wauthia and Rossignol, 2016; play in anxiety may be useful in clinical settings when it comes to
Weinberg et al., 2010). The current study integrated these two lines of assigning treatment for youth with anxiety-related disorders. Our results
research to gain insight into how top-down, attentional control modu­ suggest that those youth who engage in less error-monitoring may
lates the influence of the bottom-up, enhanced error monitoring typi­ benefit from treatment focused on shifting and redirecting their atten­
cally observed in individuals with anxiety. The current findings indicate tion when faced with “threat”.
that youth who display both a low response to internal threat (i.e.,
making an error) and higher ability to flexibly shift attention had the Declaration of Competing Interest
lowest levels of anxiety. In contrast, youth who have difficulty shifting
attention had relatively high levels of anxiety, even when the error None
response is small. Further, youth with high shifting ability and
enhanced, more negative ERN response also had relatively high levels of Acknowledgments
anxiety suggesting that higher levels of attentional shifting are not suf­
ficient to modulate anxiety when hypervigilance to error (i.e., threat Work on this project was supported by National Institute of Mental
detection) is high. Health grants R34 MH097931, R01 MH119299, and R01 MH079943 to
Taken together, results are in line with the attentional control theory Jeremy W. Pettit and Wendy K. Silverman, and a National Institute of
which postulates that anxiety hinders the ability to shift attention away Mental Health grant F31 MH105144–01A1 to Michele Bechor. The
from distracting, task-irrelevant stimuli (Eysenck et al., 2007). Further, content is solely the responsibility of the authors and does not neces­
they highlight the interplay between attentional control and error sarily represent the official views of the National Institutes of Health.
monitoring in youth anxiety. Anxiety levels are low when both atten­
tional shifting is high and error monitoring (ERN) is small. It appears Supplementary materials
that a specific aspect of attentional control, shifting, is key to moderating
the association between error monitoring and anxiety in youth. This key Supplementary material associated with this article can be found, in
role of attentional shifting in the presence of an internal threat (i.e., an the online version, at doi:10.1016/j.pscychresns.2022.111507.
error) is consistent with prior research indicating that anxious in­
dividuals have difficulty disengaging attention from external threats (i. References
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