title: Modulation of error monitoring in obsessive-compulsive disorder by individually tailored symptom provocation.
abstract: BACKGROUND
  The enhanced error monitoring in patients with obsessive-compulsive disorder (OCD), typically measured with the error-related negativity (ERN), has been found to be temporally stable and independent of symptom expression. Here, we examined whether the error monitoring in patients with OCD could be experimentally modulated by individually tailored symptom provocation.
  
  
  METHODS
  Twenty patients with OCD and 20 healthy controls performed a flanker task in which OCD-relevant or neutral pictures were presented prior to a flanker stimulus. An individualized stimulus set consisting of the most provoking images in terms of OCD symptoms was selected for each patient with OCD. Response-locked event-related potentials were recorded and used to examine the error-related brain activity.
  
  
  RESULTS
  Patients with OCD showed larger ERN amplitudes than did control subjects in both the OCD-symptom provocation and neutral conditions. Additionally, while patients with OCD exhibited a significant increase in the ERN under the OCD-symptom provocation condition when compared with the neutral condition, control subjects showed no variation in the ERN between the conditions.
  
  
  CONCLUSIONS
  Our results strengthen earlier findings of hyperactive error monitoring in OCD, as indexed by higher ERN amplitudes in patients with OCD than in controls. Importantly, we showed that the patients' overactive error-signals were experimentally enhanced by individually tailored OCD-symptom triggers, thus suggesting convincing evidence between OCD-symptoms and ERN. Such findings imply that therapeutic interventions should target affective regulation in order to alleviate the perceived threatening value of OCD triggers.
authors.affiliation: Department of Psychiatry,Chuncheon Sacred Heart Hospital,Hallym University College of Medicine,Chuncheon-si,Gangwon-do,Republic of Korea.
authors.forename: D
authors.initials: D
authors.lastname: Roh
authors.affiliation: Department of Psychiatry,Severance Hospital,Seoul,Republic of Korea.
authors.forename: J-G
authors.initials: JG
authors.lastname: Chang
authors.affiliation: Yoo and Kim Mental Health Clinic,Seoul,Republic of Korea.
authors.forename: S W
authors.initials: SW
authors.lastname: Yoo
authors.affiliation: Department of Psychiatry,Severance Hospital,Seoul,Republic of Korea.
authors.forename: J
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Psychiatry,Severance Hospital,Seoul,Republic of Korea.
authors.forename: C-H
authors.initials: CH
authors.lastname: Kim
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology*; D005071:Evoked Potentials / Q000502:physiology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology*; D055815:Young Adult
keywords: electroencephalography; emotion regulation; error-related negativity; event-related potential; obsessive–compulsive disorder; symptom provocation