The role of performance monitoring in psychopathology

This PhD dissertation investigates the role of performance monitoring in psychopathology. Performance monitoring is a cognitive control process, that includes the processing of error-making and conflict information. These cognitive processes are driven by brain activity of predominately the anterior cingulate cortex. Like with many cognitive control processes (such as inhibition), this ability of the brain to process information is important for emotion and behavior regulation. Ample research confirms that cognitive control processes play an influential role in the risk of developing or the progression of mental disorders, such as addiction and anxiety. In the studies of this dissertation, the role of behavioral and neurophysiological measures of error processing and conflict processing in psychopathology are examined using different study designs and samples. A re-occurring performance monitoring task applied in this dissertation is the flanker task.

The first study includes a meta-analysis on error-related negativity (ERN) and error positivity (Pe) in externalizing disorders. As expected, the ERN and Pe are systematically smaller in patients with ADHD and addiction when compared to healthy controls. The second study is a narrative review assessing whether error processing can be considered a biomarker for externalizing disorders. This review that performance monitoring can be considered a biomarker for externalizing disorder. This study also identifies important future research avenues to address remaining questions, such as the role of performance monitoring in behavioral addictions. The third study explores the growth trajectory of response times of the flanker task in a large sample of primary school children. Also, this study describes the associations between the response times trajectory and the trajectory of emotional and behavioral problems. Furthermore, this chapter provides unique insight into post-error slowing, response strategies, and congruency effects across childhood. The final study is a pilot study using a social flanker task in an MRI study in adults. The social flanker task allows the studying of affective performance monitoring as the tasks include peer observation during performance, inducing performance anxiety. The sample used in the final study comes from a longitudinal study on the effect of behavioral inhibition on emotional-social development.

The studies in the current thesis confirm the role of performance monitoring in psychopathology. The results of this thesis provide three future steps. First, future research should focus on the theoretical framework around performance and error processing, together with other cognitive control processes, in psychopathology. An example of this is testing the direct links between performance monitoring, observed behavior, and e.g. symptom severity reduction. Second, a developmental perspective on cognitive control in psychopathology is needed to deepen our understanding of the etiology and recovery of disorders. Last, if brain processes are related to psychopathology, brain stimulation, and training can be piloted as additional treatment options for patients.