Faced with the pressures of constant testing, demanding extracurriculars, and a new lifestyle away from home, it comes as no surprise that anxiety is a major mental health concern among college students. In fact, according to a survey performed by the American College Health Association, reports of anxiety have increased among undergraduates in the last five years. In Fall 2011, 20.4% of undergraduate students reported feeling “overwhelming anxiety” in the last two weeks, while that number had risen to 29.8% by Fall of 2016. Additionally, university mental health counseling centers have seen steep increases (nearly 40%) in the number of students diagnosed with anxiety. The most common type of anxiety disorder is Generalized Anxiety Disorder (GAD), in which an individual excessively worries about everyday issues, even if those issues are uncontrollable. Treatment for GAD and other anxiety disorders usually involves a combination of therapy and medication. From a clinical point of view, understanding the psychological mechanisms underlying anxiety disorders is essential to developing these treatments effectively.

 

One psychological hallmark of individuals with anxiety is an increased “error-related negativity” (ERN) in response to an error made in a task where an individual must make a choice. The ERN is a type of event-related potential, which is an electrical response that brain cells generate when faced with a stimulus. In everyday life, the ERN is useful for us to detect our errors in accuracy and to compensate for any erroneous behavior we may make. However, the increased ERN experienced by anxiety-afflicted individuals means that those individuals have an abnormally large response to any errors they make. This may be caused by a heightened fear of threat resulting from the error or by a larger compulsion to compensate for the error.

 

Either way, researchers have believed for some time that reducing the magnitude of the ERN could be an effective method in treatment of anxiety. However, behavioral therapy (a general, common form of therapy for GAD and other anxiety disorders) is ineffective at reducing the ERN. Instead, targeted interventions aimed at ERN reduction are more effective. Unfortunately, few of these interventions have been well-characterized and researched, so in September of 2017, psychologists at the University of Michigan set out to explore one intervention strategy that showed promise in reducing the ERN: expressive writing. In this study, “expressive writing” meant disclosure of one’s thoughts and emotions regarding a particular event.  Expressive writing has been shown in the past to reduce anxiety by “offloading” worries, allowing the brain to be less distracted. Thus, the researchers hypothesized that expressive writing before a menial task would help anxious individuals feel less compelled to compensate for any errors they made during the task, leading to a decreased ERN .

 

To experiment with this hypothesis, the researchers tested forty female college students suffering from GAD. The gender of the students was important because the ERN is especially heightened in female anxiety-sufferers, as opposed to males. The students were divided into two groups and asked to write for eight minutes: the “unrelated writing” group wrote about their routine of the previous day, while the “expressive writing” group wrote about any worries or concerns disturbing them at the moment. Both groups were then left to sit and reflect for four minutes. Next, they performed a “Flanker task” in which they would respond to a target letter on a computer screen by pressing either the “a” key or the “l” key, depending on the letter shown. Since the ERN is a type of event-related potential, it generates an distinct electrical signal in the brain. Thus, the ERN and brain activity of the subjects was measured throughout the task by attaching EEG (electroencephalography) caps and sensors to the brain.

 

The results of the experiment showed that, while the expressive writing group did not make fewer errors or exhibit any behavioral change in comparison to the unrelated writing group, the ERN was significantly reduced in the expressive writing group. The reduction was from a mean ERN of -7.17 in the unrelated group to a mean ERN of -5.71 in the expressive writing group, an improvement of 20%. Interestingly, when both groups were asked to self-report their feelings of anxiety after the test, the expressive writing group actually demonstrated higher levels of anxiety, despite the reduced ERN. However, the researchers were primarily interested in targeted interventions for the ERN, rather than general therapeutic strategies. Thus, the results were consistent with their hypothesis that expressive writing reduces the ERN.

 

As mental health issues become increasingly prevalent, this study served as an important step in advancing understanding of the ERN in anxiety sufferers. It also confirmed that the ERN can be modified relatively easily through targeted intervention, rather than general anti-anxiety therapy or medication. However, there is more to study in terms of the mechanism underlying ERN reduction and the degree to which ERN reduction is an effective treatment for anxiety. With further research, the ERN could become an important target for anti-anxiety therapeutics that alleviate clinical anxiety among college students and the general public.


REFERENCES

1. American College Health Association. American College Health Association-National College
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3. Kujawa, A., Weinberg, A., Bunford, N., Fitzgerald, K. D., Hanna, G. L., Monk, C. S., … Phan, K. L.
(2016). Error-related brain activity in youth and young adults before and after treatment for generalized or social anxiety disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 71, 162–168.
4. Moran, T. P., Taylor, D., & Moser, J. S. (2012). Sex moderates the relationship between worry
and performance monitoring brain activity in undergraduates. International Journal of
Psychophysiology, 85, 188–194.
5. Moser, J. S., Moran, T. P., Schroder, H. S., Donnellan, M. B., & Yeung, N. (2013). On the
relationship between anxiety and error monitoring: A meta-analysis and conceptual framework. Frontiers in Human Neuroscience, 7, 1–19.
6. Schroder HS, Moran TP, Moser JS. The effect of expressive writing on the error-related
negativity among individuals with chronic worry. Psychophysiology. 2017;00:1–11.

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