(Picture: Ella Byworth for Metro.co.uk)

Working on your mental health includes a lot of trial and error.

Will this type of therapy help? Will these pills do anything? Might as well try it out and see what happens.

A new test could take the guesswork out of treating anxiety, meaning we’d be able to get the right help more quickly.

A study published in Neuropsychopharmacology noted that patients with higher levels of anxiety exhibit more electrical activity in their brains when they make a mistake (or what they perceive to be a mistake), which can be measured using electroencephalography (EEG) that records the brain’s electric signals. Researchers call this ERN (error-related negativity).




The higher someone’s anxiety, the more exaggerated the ERN response when they make a mistake.

UIC psychiatrist Stephanie Gorka explains: ‘This is a biological internal alarm that tells you that you’ve made a mistake and that you should modify your behavior to prevent making the same mistake again. It is useful in helping people adapt, but for those with anxiety, this alarm is much, much louder.’

So essentially, your brain overreacts, responding to little things as though they’re huge, dangerous mistakes. Sound familiar?

Researchers wanted to see whether differences in ERN could predict which treatment worked best. They asked 60 volunteers with various anxiety disorders, plus 26 people with no history of psychological disorders, to wear an EEG cap to measure their ERN levels while performing difficult computer tasks.

(Picture: Ella Byworth for Metro.co.uk)

The tasks were deliberately tricky so everyone would make mistakes, allowing researchers to analyse the people’s ERN responses and, thus, the level of their anxiety.

Researchers then asked participants to either take an SSRI antidepressant every day for three months, or have cognitive behavioural therapy (CBT) every week for three months.

After those three months, the patients took the same computer test, again wearing EEG caps.

Those who’d exhibited higher ERN levels at the study’s beginning had reduced anxiety levels if they’d been treated with CBT – more so than those who were treated with medication.

This could indicate that those with higher ERN levels, who react more strongly to their own mistakes, could be more receptive to CBT than other patients. Researchers reckon this is because high ERN indicates that someone is thinking a lot about their own actions and emotions, so will be more able to try to change patterns of thinking).

‘BBT is all about learning new techniques for reducing anxiety and learning to reframe overly negative ideas or feelings,’ explains Gorka. ‘People highly attuned to their own behavior, as evidenced by their enhanced ERN, might just be more receptive and attentive to the lessons learned through CBT.’

The researchers now believe that their findings could be used to quickly work out which treatment plan would be most beneficial for an individual patient. If doctors could measure people’s ERN, they’d be able to recommend CBT to those who may benefit from it the most.

The handy thing is that the EEG equipment used to work out someone’s ERN isn’t too expensive and the test isn’t hugely time-consuming. So doctors could actually incorporate the test in their appointments.



Obviously the test was pretty small and more research is needed, but it’s an interesting idea – and anything that could help anxious people feel better more quickly can only be a wonderful thing.

‘Using EEG to measure ERN before deciding on a treatment give us a simple and objective way to help more people get the right treatment the first time around,’ said Dr. K. Luan Phan, a senior author on the paper.

‘Patients tend to leave treatment when the first attempt fails to reduce their symptoms. Once people drop out, we lose the opportunity to take care of them, and ultimately these patients continue to suffer from their anxiety.’

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