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

Abstract

Anxiety disorders are associated with enhanced defensive reactivity to errors, measured via the error-related negativity (ERN). There is some evidence to suggest that problematic alcohol use is also associated with an enhanced ERN; although prior studies have been almost exclusively in men and have yet to examine the potential interactive effects of anxiety and alcohol abuse symptoms. The aim of the current study was to address the gaps in this literature by examining the unique and interactive effects of anxiety symptoms and problematic alcohol use on the ERN in a sample of 79 heterogeneous internalizing disorder patients. All participants completed a flanker task designed to robustly elicit the ERN and questionnaires assessing current internalizing symptoms and problematic alcohol use. As expected, results revealed that greater anxiety symptoms, but not depressive symptoms, were associated with a more enhanced ERN. There was no main effect of problematic alcohol use but there was a significant anxiety by problematic alcohol use interaction. At high anxiety symptoms, greater problematic alcohol use was associated with a more enhanced ERN; at low anxiety symptoms, alcohol use was unrelated to the ERN. There was no depression by alcohol abuse interaction. The findings suggest that within anxious individuals, heightened reactivity to errors/threat may be related to risk for alcohol abuse. The findings also converge with a broader literature suggesting that heightened reactivity to threat may be a shared vulnerability factor for anxiety and alcohol abuse and a novel prevention and intervention target for anxiety-alcohol abuse comorbidity.

Keywords: Alcohol abuse; Anxiety; Error-related negativity; Psychophysiology; Threat sensitivity.

Figure 1

On the left, topographic map of neural activity (error minus correct) across the entire sample. On the right, response-locked ERP waveform for correct and error trials, as well as the difference waves (error-related negativity; ΔERN) across the entire sample.

Figure 2

A) Graph illustrating the effect of problematic alcohol use on the ΔERN at high and low levels of anxiety symptoms (± 1 standard deviation from the mean). B) Scatter plot depicting the effect of problematic alcohol use on the ΔERN at high and low anxiety symptoms (median split). ΔERN = difference between error-related negativity and correct-related negativity; DASS = Depression, Anxiety, and Stress Scale; AUDIT = Alcohol Use Disorders Identification Test.