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Background Reduced reward responsiveness, measured via the event-related potential (ERP) component the reward positivity (RewP), has been linked to several internalizing psychopathologies (IPs). Specifically, prior studies suggest that a reduced RewP is robustly related to depression and to a lesser extent anxiety. No studies to date, however, have examined the relation between the RewP and IP symptom dimensions in a heterogeneous, clinically representative patient population that includes both depressed and/or anxious subjects. The primary aim of the current study was to examine the relation between the RewP and specific internalizing symptom dimensions among patients with a variety of IP diagnoses and symptoms. Methods A total of 80 treatment seeking adults from the community completed a battery of questionnaires assessing a range of IP symptoms and a well-validated reward processing task known to robustly elicit the RewP. Results A principal components analysis (PCA) on clinical assessments revealed two distinct factors that characterized the patient sample: affective distress/misery and fear-based anxiety. Results showed that within this sample, an attenuated RewP was associated with greater affective distress/misery based symptoms; however, the RewP was unrelated to fear-based anxiety symptoms. Conclusions The current findings suggest that patients with higher distress/misery symptoms are characterized by decreased responsivity to rewards at the physiological level, and that this response tendency distinguishes distress/misery symptoms from fear-based symptoms. The RewP may be one promising transdiagnostic biological target for intervention efforts for individuals with distress-based symptoms of psychopathology.

Objective: Given increasing rates of daily cannabis use and Cannabis Use Disorder (CUD) in the United States, it is imperative to understand CUD mechanisms in high-risk groups. Cannabis users with high distress intolerance (DI) are at elevated risk for severe and chronic CUD, but neural mechanisms linking CUD and DI are unknown. Cross-sectional data suggests that acute stress modulation of the cannabis and threat cue-elicited late positive potential (LPP), a neurophysiological marker of motivated attention, are possible mechanisms. However, longitudinal research is needed to clarify the roles of these elicited LPPs in CUD maintenance. Method: Sixty cannabis users with high DI were randomized a brief computerized intervention targeting DI or a control intervention. Elicited LPPs were measured before and after a stressor at baseline and postintervention. Intervention effects on stress modulation of the cannabis and threat LPPs, as well as their prospective associations with CUD, were assessed. Results: Elicited LPPs did not significantly change in either intervention group. Acute stress enhancement of the cannabis LPP predicted more severe CUD and greater chronicity at 4-month follow-up. Conclusions: Cannabis and threat LPPs were not altered by a brief DI intervention despite improvement in DI and cannabis use outcomes. Given that acute stress enhancement of the cannabis LPP predicted poorer CUD outcome, it may be a fruitful intervention target in distress intolerant cannabis users. Public Health Significance StatementCannabis users with high distress intolerance are at heightened risk for Cannabis Use Disorder. This study demonstrates that a brief intervention for distress intolerant cannabis users did not affect the neurophysiological response to cannabis cues, but stress modulation of the cue-elicited response predicted worse intervention response. Stress modulation of cannabis cue reactivity may be a fruitful intervention target in this population.

Increased neural error monitoring, as measured by the error-related negativity (ERN), is a transdiagnostic neurobiological marker of anxiety. To date, little is known about whether the ERN can inform the choice between first-line anxiety disorder treatments and whether the ERN changes following treatment completion. The aim of the study was to therefore assess whether the ERN is a treatment moderator and index of symptom change during cognitive-behavioral therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs). Participants included adult volunteers (M age=25.8±8.5; 67% female) with principal anxiety disorders (n=60) or no lifetime history of Axis I psychopathology (ie, healthy controls; n=26). A flanker task was used to elicit the ERN at baseline and 12 weeks later, following either CBT or SSRIs in the patient sample. Results indicated that baseline ERN was a significant treatment moderator such that a more enhanced baseline ERN was associated with greater reduction in anxiety symptoms within individuals who received CBT but not SSRIs. Results also revealed that the ERN increased pre- to post-treatment among patients randomized to SSRIs, but remained stable among patients randomized to CBT and healthy controls. Together, these novel findings highlight that ERN may help guide treatment decisions regarding engagement in CBT or SSRIs, especially among individuals with an enhanced ERN. The findings also suggest that SSRIs have the capacity to alter individual differences in the ERN, providing evidence that the ERN is not entirely static in patients with anxiety disorders.

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