Double jeopardy! The additive consequences of negative affect on performance-monitoring decrements following traumatic brain injury.

Survivors of severe traumatic brain injury (TBI) are at increased risk for emotional sequelae. The current study utilized the error-related negativity (ERN) and posterror positivity (Pe) components of the event-related potential (ERP) to test the hypothesis that negative affect disproportionately impairs performance-monitoring following severe TBI. High-density ERPs were acquired while 20 survivors of severe TBI and 20 demographically matched controls performed a single-trial Stroop task. Response-locked ERPs were separately averaged for correct and error trials. Negative affect was measured as the single latent factor of measures of depression and anxiety. Groups did not differ on overall level of negative affect. Control and TBI participants did not differ on error rates as a function of negative affect, but differed in response times. ERP results revealed disproportionately smaller ERN amplitudes in participants with TBI relative to controls as a function of negative affect. Pe amplitude did not differ between groups. Negative affect inversely correlated with ERN amplitude in TBI but not control participants. Overall, results support a "double jeopardy" hypothesis of disproportionate impairments in performance monitoring when negative affect is overlaid on severe TBI.