Social Neuroscience

ISSN: 1747-0919 (Print) 1747-0927 (Online) Journal homepage: http://www.tandfonline.com/loi/psns20

Social context modulates cognitive markers in

Obsessive-Compulsive Disorder

Hernando Santamaría-García, Carles Soriano-Mas, Miguel Burgaleta, Alba

Ayneto, Pino Alonso, José M. Menchón, Narcis Cardoner & Nuria Sebastián-
Gallés

To cite this article: Hernando Santamaría-García, Carles Soriano-Mas, Miguel Burgaleta, Alba
Ayneto, Pino Alonso, José M. Menchón, Narcis Cardoner & Nuria Sebastián-Gallés (2017): Social
context modulates cognitive markers in Obsessive-Compulsive Disorder, Social Neuroscience,
DOI: 10.1080/17470919.2017.1358211

To link to this article: https://doi.org/10.1080/17470919.2017.1358211

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SOCIAL NEUROSCIENCE, 2017
https://doi.org/10.1080/17470919.2017.1358211

ARTICLE

Social context modulates cognitive markers in Obsessive-Compulsive Disorder

Hernando Santamaría-Garcíaa, Carles Soriano-Masb,c,d, Miguel Burgaletaa, Alba Aynetoa, Pino Alonsob,c,e,
José M. Menchónb,c,e, Narcis Cardonerb,c,e and Nuria Sebastián-Gallésa
a
Center for Brain and Cognition, Department of Technology, Universitat Pompeu Fabra, Barcelona, Spain; bDepartment of Psychiatry,
Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; cDepartment of Psychiatry, CIBERSAM
(Centro de Investigación Biomédica en Red de Salud Mental), Barcelona, Spain; dDepartment of Psychobiology and Methodology of Health
Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain; eDepartment of Clinical Sciences, School of Medicine, University of
Barcelona, Barcelona, Spain

ABSTRACT ARTICLE HISTORY

Error monitoring, cognitive control and motor inhibition control are proposed as cognitive Received 21 June 2016
alterations disrupted in obsessive-compulsive disorder (OCD). OCD has also been associated Revised 3 May 2017
with an increased sensitivity to social evaluations. The effect of a social simulation over electro- Published online 2 August
2017
physiological indices of cognitive alterations in OCD was examined. A case-control cross-sectional
study measuring event-related potentials (ERP) for error monitoring (Error-Related Negativity), KEYWORDS
cognitive control (N2) and motor control (LRP) was conducted. We analyzed twenty OCD patients Social hierarchy;
and twenty control participants. ERP were recorded during a social game consisting of a visual obsessive-compulsive
discrimination task, which was performed in the presence of a simulated superior or an inferior disorder; evoked potentials;
player. Significant social effects (different ERP amplitudes in Superior vs. Inferior player condi- error monitoring process;
tions) were found for OCD patients, but not for controls, in all ERP components. Performing the cognitive control; motor
task against a simulated inferior player reduced abnormal ERP responses in OCD to levels control
observed in controls. The hierarchy-induced ERP effects were accompanied effects over reaction
times in OCD patients. Social context modulates signatures of abnormal cognitive functioning in
OCD, therefore experiencing a social superiority position impacts over cognitive processes in OCD
such as error monitoring mechanisms. These results open the door for the research of new
therapeutic choices.

Introduction Moreover, different studies have provided compelling

evidence of the impact of social context on cognitive
Fronto-striatal circuits are essential for behavioural regula-
functioning in healthy subjects (Santamaría-García,
tion mechanisms such as error monitoring and cognitive
Pannunzi, Ayneto, Deco, & Sebastián-Gallés, 2013; Zink
and motor control processes (Koban & Pourtois, 2014;
et al., 2008). In other words, establishing social compar-
Mansouri, Tanaka, & Buckley, 2009). Together, those cogni-
isons with fellow individuals, or experiencing a role within
tive processes have been postulated to be at the core of
a social context i.e., adopting a dominant social position
cognitive alterations in OCD (Chamberlain et al., 2008;
(social superiority) or a submissive position (social infer-
Dittrich & Johansen, 2013; Menzies et al., 2007; Purcell,
iority), can influence a wide array of cognitive processes,
Maruff, Kyrios, & Pantelis, 1998). As in other mental disor-
such as sensory-perceptual mechanisms (Chiao et al.,
ders with anxiety symptoms, OCD is also associated with an
2008; Santamaría-García et al., 2013), decision-making
increased sensitivity to social evaluations, leading to impair-
(Rilling & Sanfey, 2011), feedback assessment (Boksem,
ments in social functioning (Grisham, Henry, Williams, &
Kostermans, Milivojevic, & De Cremer, 2011), and execu-
Bailey, 2010; Harrison et al., 2012; Koban & Pourtois, 2014).
tive functions (Smith, Dijksterhuis, & Wigboldus, 2008;
Indeed, OCD patients display disruptions in their ability to
Smith, Jostmann, Galinsky, & van Dijk, 2008).
interact with other individuals and generally show inflex-
The above-presented findings become especially rele-
ibility (Dittrich & Johansen, 2013) as well as, anxiety symp-
vant in the context of the altered social sensitivity typically
toms related to social evaluations (Calkins, Berman, &
described in OCD patients (Grisham et al., 2010). The
Wilhelm, 2013; Grisham et al., 2010; Pace, Thwaites, &
current study addresses to what extent the social context
Freeston, 2011).

CONTACT Hernando Santamaría-García nanosanta@gmail.com; hernando.santamaria@javeriana.edu.co Carrer tanger 122, (80018) Barcelona, Spain;
Carles Soriano-Mas carles.soriano.mas@gmail.com Bellvitge Biomedical Research Institute-IDIBELL, Psychiatry Department, Bellvitge University
Hospital, Feixa Llarga s/n 08907, Hospitalet de Llobregat, Barcelona, Spain
The supplemental data for this article can be accessed here
© 2017 Informa UK Limited, trading as Taylor & Francis Group
2 H. SANTAMARÍA-GARCÍA ET AL.
may modulate fronto-striatal activity underlying core cog-
nitive processes in OCD such as increased self-monitoring,
difficulties in cognitive control and disrupted motor con-
trol mechanisms. For this purpose we used Event Related
Potentials (ERP), which reliably reflect error monitoring,
cognitive and motor control (Danielmeier, Wessel,
Steinhauser, & Ullsperger, 2009; Falkenstein, Hoormann,
Christ, & Hohnsbein, 2000; Kappenman et al., 2012;
Melloni et al., 2012; Otten & Jonas, 2013). In particular,
error monitoring activity is captured by the Error Related
Negativity (ERN) and Error Positivity (Pe) components
(Chamberlain & Menzies, 2009; Endrass et al., 2010; van
Veen & Carter, 2006), while mechanisms of cognitive con-
trol and conflict adaptation can be measured by the
frontal N2 component (Otten & Jonas, 2013; Yeung &
Cohen, 2006). Motor control and inhibition processes are
reflected in the Lateralized Readiness Potentials (LRP-r)
(Ibanez et al., 2012; Kappenman et al., 2012; Töllner,
Rangelov, & Müller, 2012).
Different studies have reported larger amplitudes of
ERN and Pe components in OCD patients, reflecting an
amplified error-monitoring processing (Melloni et al.,
2012; Menzies et al., 2007; Riesel, Endrass, Kaufmann,
& Kathmann, 2011). The ERN component is a robust,
trait-like electrophysiological index associated to the
functioning of the error-detection system (including
the anterior cingulate cortex), which is considered a
quantitative endophenotype of OCD. The ERN has
shown to be non-directly affected by disorder severity
or by the treatment (Menzies et al., 2007; Olvet &
Hajcak, 2008; Riesel et al., 2011), (Stern et al., 2010).
Additionally, the Pe component has been described as
an index of awareness in detecting errors and has been
associated to activity in the posterior cingulate cortex
(Endrass et al., 2010; van Veen & Carter, 2006). These
alterations in error processing underlie OCD’s obsessive
thoughts, concern over mistakes, high expectations
from other people’s evaluations and repetitive beha-
viours (Endrass et al., 2010; Melloni et al., 2012).
Therefore, given the well-established role of the ERN/
Pe as a neuromarker of OCD, the main goal of this
research was to assess to what extent the social context
modulates such OCD-specific error monitoring compo-
nents in comparison to healthy subjects.
Furthermore, disruptions in cognitive and motor
control mechanisms may also stem from OCD’s fronto-
striatal dysfunction (Folstein & Van Petten, 2008; Otten
& Jonas, 2013; Yeung & Cohen, 2006). Though larger
amplitudes in N2 are associated with high conflict
adaptation and improved cognitive control (Folstein &
Van Petten, 2008), OCD patients have exhibited lower
negativities in the N2 fronto-central component, argu-
ably reflecting their impaired cognitive control skills (Lei
et al., 2015; Melloni et al., 2012). The LRP-r component,
in turn, captures cognitive control processes that
extend into immediate control of action, encompassing
response, inhibition, response conflict, and error mon-
itoring (Danielmeier, Wessel, Steinhauser, & Ullsperger,
2009; Johannes et al., 2001). Available evidence has
shown an altered pattern of LRP-r component in OCD
patients, which has been hypothesized to be due to a
dysfunctional fronto-striatal circuitry, likely underlying
impairments in motor inhibition related to compulsive
behaviour (Johannes et al., 2001; Lei et al., 2015). Thus,
our complementary goal was to explore how the social
context could modulate the N2 and LRP-r components
in OCD patients in comparison to healthy subjects.
In this study, a sample of OCD patients and healthy
controls took part in an experimental framework in
which the social context was created by using a social
hierarchy (Santamaría-García, Burgaleta, & Sebastián-
Gallés, 2015; Santamaría-García et al., 2013; Zink et al.,
2008). Previous studies have reported that across ani-
mal species social hierarchy is a crucial social domain
involved in different biological processes such as survi-
val, reproductive success, cognitive processing, motiva-
tion and social behaviour regulation (Boyce, 2004;
Mehta, Jones, & Josephs, 2008; Sapolsky, 2004; Zink
et al., 2008). In this study ERP data was recorded while
participants played a game consisting of a difficult
visual decision task (numerosity) in the presence of
simulated inferior or superior players. Playing in the
presence of an inferior player was expected to confer
a superiority position to the participant, whereas play-
ing in the presence of a superior player would have the
opposite effect (Santamaría-García et al., 2015;
Santamaría-García et al., 2013). Aiming to connect our
findings with the clinical features of the disorder, within
the group of OCD patients, we evaluated to what
extent the ERP and behavioural data during the social
context correlate with the clinical measurements of
OCD symptoms’ severity and the severity of comorbid
depressive and anxiety symptoms.
We predicted that OCD patients, but not controls,
would display lower ERP amplitudes in the inferior
player than in the superior player condition for the
ERN/Pe and LRP-r components, and the inverse pattern
for the N2 component (denoting, respectively, reduc-
tion of error detection hyperactivity, enhanced motor
control and better cognitive control when patients
adopted a superiority position). Furthermore, if the
social effect is indeed a key factor for OCD cognitive
impairments, then it is expectable that the OCD pattern
of brain activity, when performing the task in a super-
iority position, would tend to approach the brain activ-
ity levels observed for control participants. In addition,
 SOCIAL NEUROSCIENCE 3

such differences in brain processing would be paral- Table 1. Clinical characteristics of OCD patients.
leled by behavioural changes, so that the presence of Variable Mean (SD), range
a social context might affect the accuracy and the Age, yrs a 33.1 (8.3), 27–40
Gender, m/f b 37/32
reactions times (RT) in the visual decision task. Education, yrs c 13.75 (2.8), 5–19
HDRS 11.7 (4.8), 6–18
HARS 18.1 (4.4), 16–26
Age at onset of OCD, yrs 18.8 (7.9), 5–40
Duration of illness, yrs 12.8 (9.4), 1–45
Methods Y-BOCS-Total 25.4 (2.4), 21–30
Comorbid mood/anxiety disorders no. (% cases)
Bipolar disorder type II 1 (5)
Participants Social phobia 1 (5)
Major depressive disorder 1 (5)
Twenty (right-handed) outpatients with OCD (10 females; Medication at time of study no. (% cases)
mean age 35.25, range 27 – 40 years, 13.75 ± 2.8 years of Medication-free (> 4 weeks) 2 (10)
Clomipramine 2 (10)
education, range 5–19) were recruited from the OCD Escitalopram 5 (40)
Clinic at the Bellvitge University Hospital (Barcelona, Fluoxetine 2 (10)
Fluvoxamine 2 (10)
Spain). All patients fulfilled DSM-IV criteria for OCD for a Sertraline 1 (5)
period of at least one year. Diagnoses were made on the Paroxetina 1 (5)
basis of structured interviews conducted independently HDRS = Hamilton Depression Rating Scale; HARS = Hamilton Anxiety
by two trained psychiatrists using the Structured Clinical Rating Scale; Y-BOCS = Yale-Brown Obsessive-Compulsive Scale.

Interview for DSM-IV Axis I Disorders-Clinician Version

(SCID-CV). Exclusion criteria were aged under 18 or over
65 years, psychoactive substance abuse/dependence
(either current or in the past six months), mental retarda-
tion, psychotic or bipolar disorders, or severe organic or
neurological pathology. Comorbid major depression and
other anxiety disorders were not considered an exclusion
criterion provided that OCD was the main diagnosis and
the primary reason for seeking assistance. All the patients
had been taking stable doses of medication for at least
3 months prior to the time of testing. OCD severity was
assessed using the Spanish version of the clinician-admi-
nistered Yale-Brown Obsessive-Compulsive Scale (Y-
BOCS) (Vega-Dienstmaier et al., 2002), and depressive
and anxiety symptoms were assessed by means of the
17-item Hamilton Depression Rating Scale (HDRS)
(Hamilton, 1960) and 14-item Hamilton Anxiety Rating
Scale (HARS) (Hamilton, 1959). Table 1 provides the clin-
ical information of the OCD participants. Twenty (right-
handed) healthy controls from the same socio-demo-
graphic environment and with a comparable age and
gender distribution (10 females; mean age 33.59; age
range 29 – 40 years 13.2 +/- 1.8 years of education,
range 10–16) were also included. Each control subject
underwent the Structured Clinical Interview for DSM-IV
non-patient version to exclude the presence of any Axis I
psychiatric disorder. Remaining exclusion criteria were the
same as those applied to OCD patients. Written informed
consent was obtained from each participant after a full
description of the study, which was conducted in compli-
ance with national legislation and the principles set out in
the Declaration of Helsinki. The ethics committee of
Bellvitge University Hospital and the ethics committee of
the Brain Cognition Centre of the Pompeu Fabra
University also approved the study.
Materials
Social context setting
Social context was created using a procedure validated
in previous studies (Zink et al., 2008) (Santamaría-García
et al., 2013) (see Figure 1). We used brief social videos
to introduce simulated players’ profiles and establish
the initial hierarchical features, followed by an interac-
tive game in which the participants performed a visual
discrimination task in the presence of other (simulated)
players and received updated information about both
participant’s and opponent’s performance to generate a
continuous social comparison context.
Social videos. A total of eight different video profiles
(approximately 2 min each) were created. The profiles
crossed gender (male, female) and hierarchy (high, low
status), and were interpreted by four confederates (two
males, two females). Each confederate followed two
scripts (high or low status) that presented the character’s
personal, work and academic achievements. Implicit cues
related to the social superiority of the confederates were
controlled to avoid substantial differences in age, facial
expressions and attire. Each participant saw two video
profiles, one for the superior player and one for the
inferior player. Half of the participants saw the superior
and then the inferior confederate, while the other half
saw them in the reverse order.
Visual discrimination task. In each trial of the visual
discrimination task, we presented two rectangles of
red dots (of constant diameter, shape and brightness)
on a black background, one at the top of the screen,
and the other at the bottom. The two rectangles
4 H. SANTAMARÍA-GARCÍA ET AL.

Figure 1. General procedure. The procedure consisted of three stages: Social Video Profiles (stage 1), Neutral trials (2) and Social
trials (3). During stage 2, two confederates represented the superior and the inferior player. During stage 1, participants performed
70 trials in a neutral context (here, a hierarchical scenario was avoided). During stage 3, participants performed the visual
discrimination task while comparing their performance to the simulated players.
This figure is reproduced with permission of Journal of Neuroscience.

contained a different number of dots, and partici-
pants were asked to decide which rectangle con-
tained more dots. The sum of the dots displayed in
the two rectangles was 1000 dots, each rectangle
having a different percentage of this total amount.
The percentage of red dots was complementary
between the rectangles (e.g., if one had 49% of the
dots, the other had 51%; see Figure 1). We created
nine levels of dot percentages (44, 46, 48, 49, 50, 51,
52, 54, 56). The visual discrimination task and the
dynamic game structure were designed using
MATLAB version 7.9.0 (R2009b) with the
Psychophysics Toolbox version 3.0.8.
Procedure to build social context. Each trial of the
game started with a 2 s presentation of the opponent’s
photograph, along with three or one ranking stars (for
the superior and inferior player respectively), followed
by the visual discrimination task. The dot rectangles
were presented during 1 s. Participants then decided
which rectangle contained more dots and answered
with the corresponding joystick movement (up or
down) using their right hand. Behavioural Reaction
times (RT) and accuracy were recorded. They were
given feedback on their response that stayed on the
screen for 2 s. The feedback consisted of pictures of the
participant with the opponent above, and the outcome

(a money bill meaning correct, an “X” meaning incorrect
or a “time over” message) below. Both participant and
simulated player could win or lose in a trial. The trial
ended with a fixation cross for 0.5 s. The participants
could rest for up to 2 min between blocks. Regardless
of the results of the game, participants did not receive
any real monetary compensation.
In order to be familiarized with the visual task, all
participants were required to perform 70 trials of the
task in a neutral context (see Figure 1). This set of trials
was used as a baseline measure (“social-free” scenario)
of the performance of each participant. Afterward, par-
ticipants performed the visual discrimination task in the
hierarchical social context. The game began right after
training, including five blocks of 36 trials each (180
total, 90 in presence of each simulated player). In each
block (approximately 5 min), the participants played
nine consecutive trials in presence of a simulated player
followed by nine trials in presence of the other simu-
lated player, and this sequence was repeated once,
followed then by the presentation of the updated rank-
ing. Rank order was set by adjusting the superior or
inferior player’s behaviour following an algorithm pre-
viously developed (Santamaría-García et al., 2013).
To maintain the hierarchy based on skills in the
game, we simulated performance of the hierarchical
players in the game. One of the simulated players
performed, on average, better than the participant,
thus consistently holding a higher rank status. The
other simulated player showed lower performance,
and hence had a lower rank status. Important to note,
is the participant’s results were not simulated/
manipulated.
The social status simulated during the social videos
was consistent with the simulated ranking during the
game. The role played by confederates was counter-
balanced across participants. The nature of the game
was non-competitive because the participant and the
simulated players could win, lose or have different out-
comes in the same trial. As the social role of each
simulated player was maintained constant throughout
the game, the social hierarchy could be considered
stable. Thus, each participant was always in presence
of a superior (inferiority position) or an inferior player
(superiority position). The whole experiment was
designed to increase participants’ feeling of being
involved in a realistic game.
To control for possible interactions between gender
and hierarchy, male participants played with male simu-
lated participants, and female participants with females.
Participants were first informed that they would play a
visual decision game, and then were notified that their
SOCIAL NEUROSCIENCE 5
performance would be compared to that of the two
players who already completed the task, and that all
three players would be ranked depending on their
performance during the game. The participants were
told that their performance could be compared to that
of future participants as well. To reinforce the credibility
on the procedure, participants were told that at the end
of the game, they would record a brief video where
they spoke about themselves, reporting on their jobs,
activities and achievements.
EEG/ERP methods
All participants were tested in an electrically-shielded
testing room in the Neuroscience laboratories of the
Centre for Brain and Cognition (Pompeu Fabra
University, Barcelona, Spain) where electro-encephalo-
graphy (EEG) activity was recorded. Participants were
situated approximately 50 cm in front of a 19-inch
screen, at an angle of vision of around 35°. The experi-
ment began after electrode application.
The EEGs were recorded from 31 scalp sites. We
placed two bipolar electrodes above and below each
participant’s left eye to record eye movements, two
electrodes on the mastoids, and a reference electrode
on the nose. The EEG recordings were digitized at
250 Hz. All electrode impedances were below 3
KOhms. The EEG data was low and high-pass filtered
(30–0.03 Hz). All the EEG data was semi-automatically
screened offline for eye movements and muscle arte-
facts. The segments containing such artefacts were
rejected. We rejected a similar proportion of segments
(around 5%) in both groups (patients and controls). ERP
components were then extracted.
We performed two types of analyses: Stimulus-
locked (locked at presentation of visual discrimination
task, in order to analyze social modulation of N2 com-
ponent) and response-locked analyses (locked after
response selection in the visual discrimination task in
order to analyse ERN/Pe and LRP-r components). For
stimulus-locked analyses, the EEGs were segmented
into 1100-ms epochs ranging from 100 ms before
stimulus onset, to 1000 ms post onset. Before aver-
aging, segments were baseline-corrected by subtract-
ing the mean amplitude of the pre-stimulus interval
(−100–0 ms). In the response-locked analysis, the EEGs
data was segmented into 1100-ms epochs ranging
from 200 ms before response onset to 900 ms post
response. Before averaging, segments were baseline-
corrected by subtracting the mean amplitude of the
pre-stimulus interval (−200–50 ms) as done in previous
studies (-Falkenstein et al., 2000).
6 H. SANTAMARÍA-GARCÍA ET AL.
Extraction of ERP components
Error monitoring components. The ERN component
was studied in the time window 50–200 ms after
error-response, and the Pe component was analyzed
between 500–650 ms upon error-response. Both com-
ponents were studied in the same group of frontocen-
tral electrodes (F3, F4, FZ), following previous studies
(Melloni et al., 2012; Xiao et al., 2011). Mean amplitudes
in these electrodes were averaged. Note that we pre-
viously found no significant differences in modulation
of ERN and Pe in these electrodes (p > .1).
Frontal N2 component. The frontal N2 component
was studied in the range of 250-350ms after stimulus
onset, in frontocentral electrodes (FZ /F3/F4 and CZ).
We chose these sets of electrodes and time windows
based on the topographical distribution of grand aver-
aged ERP activity and on previous studies (Folstein &
Van Petten, 2008; Yeung & Cohen, 2006). Mean ampli-
tudes in these electrodes were averaged, as no signifi-
cant differences in modulation of N2 were found
between these electrodes (p > 0.1).
Lateralized readiness potentials. LRP-r waveforms
were calculated using the difference in contralateral-ipsi-
lateral activation for C3 and C4 electrode pairs in each
hemisphere, following previous studies (Miller, Patterson,
& Ulrich, 1998; Töllner et al., 2012). LRP-r components
were computed using a baseline of −800 to −600 ms for
response-locked averages. Given that participants used
their right hand to respond, we computed a contralateral
(C3) – ipsilateral (C4) difference waveform. Such waveform
was extracted separately for each condition (trials in pre-
sence of superior player vs. trials in presence of inferior
player). LRP-r amplitudes and latencies were measured
from the resulting difference waves. We used 90% of the
maximum LRP-r activation as optimal criteria for defining
LRP-r onset latencies following a procedure used in pre-
vious studies (Töllner et al., 2012; Ulrich & Miller, 2001).
The amplitudes of the LRP-r were calculated by averaging
five sample points before and after the maximum deflec-
tion obtained in the time window of 100–20 ms pre-
response. We controlled noise on latency measure using
a low-pass filter prior to the latency measures (Gaussian
impulse response function, half-amplitude cut-
off = 23.2 Hz, full width at half maximum = 18.8 ms).
Furthermore, incorrect trials and trials with artefacts
were excluded prior to averaging following previous stu-
dies (Töllner et al., 2012). A schematic figure of brain sites
of analyses of each ERP component is included in the
supplementary material (see Supplementary Figure 1).
Statistical analyses
Separate analyses of variance (ANOVA) on the ampli-
tude and latency of each component were conducted
with Group (patients vs. healthy controls) with a
between-subjects factor, and Hierarchy (superior and
inferior) with a within-subjects factor. By using
Bonferroni correction we controlled for error through
multiple comparisons in all analyses. For the sake of
completeness, we used a similar design to study poten-
tial effects over behavioural measures (mean reaction
time (RT) and accuracy). For reaction times, we have
also analyzed intra-individual variability (standard
deviation and coefficient of variation (see
Supplementary materials, section 1.2)). For both ERP
and behavioural analyses we assessed effect sizes,
which were calculated through the partial eta squared
(η2) ratio. Finally, correlations between the amplitude
of the different ERP components and clinical data were
assessed by means of Pearson correlation analyses. All
the analyses were performed using MATLAB version
7.9.0 (R2009b).
Results
ERP
We performed separate 2 × 2 ANOVAs (Group (OCD vs
healthy controls by Hierarchy (Superior vs. Inferior) for
amplitudes of the ERP components related to the function-
ing of core cognitive processes in OCD (ERN/pe, N2, LRP).
The analyses revealed a significant main effect of
Group (OCD vs. healthy controls) in the amplitudes of
all ERP components (ERN: F1, 39 = 6.32, p < .01, η2 = 0.2;
Pe: F1, 39 = 7.02, p < .01, η2 = 0.21; N2: F1, 39 = 5.67,
p < .01, η2 = 0.16; LRP-r: F1, 39 = 4.54, p < .01, η2 = 0.11).
Furthermore, the Group by Hierarchy interaction was
significant for all four analyzed components (ERN: F1,
39 = 6.05, p < .01 η2 = 0.19; Pe: F1, 39 = 5. 97, p < .05,
η2 = 0.15; N2: F1, 39 = 6.31, p < .01, η2 = 0.21; LRP-r: F1,
39 = 3. 83, p < .05, η2 = 0.06).
All components showed the same pattern of inter-
action. Firstly, effects of social hierarchy were only
observed in the patient group. For the OCD group the
ERN, Pe, N2 and LRP-r components had larger ampli-
tudes in trials played with a superior player (inferiority
position) (see Table 2, it displays the different statistical
values). Secondly, patients and controls only differed
when playing in presence of a superior player (inferior-
ity position), while showing equivalent responses in
presence of an inferior player (superiority position)
(see Table 2, and see also Figures 2–5).
 SOCIAL NEUROSCIENCE 7

Behaviour

The table shows the statistical descriptive analyses for each ERP component (Error Related Negativity, ERN; Error Related Positivity, Pe; frontal N2; response-locked Lateralized Readiness Potential, LRP-r), considering the
group (OCD, patients) and condition (performing the task against a Superior or Inferior player). F statistics, p values and N2 and effect sizes are shown for the Group by Hierarchy interaction. The “ns” symbol means no-
OCD_inf vs. Controls inf
We performed separate 2 × 2 ANOVAs (Group by
Hierarchy) for accuracy and RTs (mean and dispersion)

ns

ns

ns

ns
during the visual discrimination task. Significant results
were observed for RT-based measures, but not for accu-
racy. First, concerning mean RT analysis, we observed a
Group effect (F1, 39 = 6.29, p < .01, η2 = 0.13). On
average, OCD patients were slower than healthy con-
OCD_sup vs. Controls sup

p < 0.01; η2 = 0.29

p < 0.05; η2 = 0.17

p < 0.05; η2 = 0.31

p < 0.05; η2 = 0.19

trols. We also observed a main effect in the Group by
Statistical analyses

Hierarchy interaction (F1, 39 = 2.77, p < .04, η2 = 0.05).

Independent comparisons (for OCD patients and con-
trols) showed a significant effect of hierarchy only for
the OCD patients (p < .05, η2 = 0.06). On average, OCD
patients were faster when they performed the task in
presence of inferior players. Analyses for the control
p < 0.01; η2 = 0.19

p < 0.05; η2 = 0.15

p < 0.05; η2 = 0.06

group did not reach significant effects due to social

p < 0.01;η2 = 0.21
Group* Hierarchy

hierarchy (p > .7)(see Figure 6).

F1, 39 = 5. 97,

F1, 39 = 3. 83,
F1, 39 = 6.05,

F1, 39 = 6.31,

Correlations
Lastly, we evaluated the correlations between the ampli-
Stat.

Stat.

Stat.

Stat.

tude of each ERP component in the presence of each

Sig.

Sig.

Sig.

Sig.

hierarchical player and the scores in three different clinical

scales assessing OCD symptom severity and the severity of
Inferior
1.57

−0.49

−2.01

−0.19
2.7

2.2

3.6

1.2

comorbid depressive and anxiety symptoms (Y-BOCS,

HDRS and HARS scales, respectively). We found a significant
significant differences. Results revealed significant differences due to social hierarchy only for OCD group

correlation between the Y-BOCS score and the difference in

Table 2. Statistical descriptive for ERP components in OCD patients and healthy controls.

Control Sup vs. Control Inf = ns

Control Sup vs. Control Inf = ns

Control Sup vs. Control Inf = ns

Control Sup vs. Control Inf = ns

amplitude of the ERN component in presence of a superior

Controls

vs. inferior player (superiority position) (r = 0.42, p < .05).

Likewise, a significant correlation was also observed
Superior

between the Y-BOCS score and the amplitude of the N2

1.54

−0.52

−1.92

−0.21
2.5

2.0

3.8

1.1

component in the presence of a superior player (inferiority

position), (r = 0.52, p < .05). No significant correlations were
observed between the Y-BOCS score and behavioural mea-
sures between neither the former nor the severity of
comorbid depressive and anxiety symptoms.
Inferior
1.57

−0.74

−1.99

−0.29
2.3

2.1

4.4

1.0

Discussion
=

Can social context influence the core cognitive processes

OCD Sup vs. OCD Inf

OCD Sup vs. OCD Inf

OCD Sup vs. OCD Inf

OCD Sup vs. OCD Inf

OCD

p < 0.01; η2 = 0.11

p < 0.01; η2 = 0.24

p < 0.01; η2 = 0.29

p < 0.01; η2 = 0.16

involved in the physiopathology of OCD? More specifically,

Superior
−1.21

1.52

−0.05

−0.65

can a social hierarchy scenario modulate OCD’s fronto-

2.8

2.2

4.1

0.9

striatal alterations such as error monitoring, cognitive con-

trol and motor control processes? Here we addressed
these questions by analyzing ERP data in a social hierarchy
context, and observed striking differences between OCD
Social-Effect

Social-Effect

Social-Effect

Social-Effect

patients and healthy controls in the way contextual social

information modulates error-monitoring, cognitive control
Mean

Mean

Mean

Mean

and motor control brain activity. Critically, performing a

SD

SD

SD

SD

visual discrimination task in a superiority position (i.e.,

playing with an inferior player) reduced the levels of aber-
LRP-r
ERN
ERP

N2
Pe

rant ERP signals in OCD patients to match the normal brain

8 H. SANTAMARÍA-GARCÍA ET AL.

Figure 2. Baseline differences between OCD patients and controls in ERP components. Differences over ERN/Pe, N2 and LRP-r
components were analyzed between patients and healthy controls. Larger amplitudes were found for patients compared to controls
in ERN/Pe (A) and LRP-r (C), whereas controls displayed higher N2 amplitudes than patients (B). *p < .05.

activity patterns of healthy controls. The following para- Social effects on ERN and Pe components
graphs will discuss these results in detail.
Crucially, aside from the observed differences between
patients and controls in the ERP-based cognitive function-
ing, we observed social effects on error-monitoring pro-
ERPs results cesses, reflected in ERN and Pe modulations, as ERN and Pe
amplitudes were larger in presence of superior player than
First, we found larger amplitudes in the ERN and Pe
in presence of an inferior player (see Figure 3 and
components in patients when compared to healthy con-
Supplementary Figure 2). Higher ERN and Pe amplitudes
trols, consistently with the usual pattern reported in pre-
displayed by patients in the presence of a superior player
vious studies (Endrass et al., 2010; Riesel et al., 2011) (see
(i.e., when patients was placed in an inferiority position), are
Figure 2 and Supplementary Figure 1). Amplified error
consistent with the well-known social sensitivity of OCD
signals (larger ERN and Pe) in OCD have been hypothe-
patients (Bystritsky et al., 2001; Pace et al., 2011). In healthy
sized to underlie obsessive thoughts, concern over mis-
populations there is evidence suggesting that different
takes, high expectations from people’s evaluations and
emotional, affective or motivational factors might affect
repetitive behaviours (Endrass et al., 2010; Melloni et al.,
the amplitude of the ERN response (Fishman & Ng, 2013;
2012).
 SOCIAL NEUROSCIENCE 9

Figure 3. Social effects on Error-Monitoring processes. The upper panel shows social modulations on the ERN and the Pe
components in the OCD group. Significant differences were only found when OCD patients performed the task in the presence
of superior players (i.e., when OCD patients were placed in an inferiority position). The central panel shows no significant effects of
Hierarchy in controls. For visualization purposes, the bottom panel shows results for OCD and controls superimposed, illustrating the
significant Group x Hierarchy interaction for both ERN and Pe components. Squared regions indicate the windows of significant
interactions. * p < .05.

Melloni et al., 2012; Olvet & Hajcak, 2008). For instance, the
ERN may be influenced by certain personality traits char-
acterized by a higher emotional reaction to errors (e.g.,
high neuroticism) (Fishman & Ng, 2013). Consistently, our
results suggest that social context is of special value in the
specific case of OCD patients, perhaps because increased
social sensitivity translates into a higher emotional load
associated with the hierarchical scenario.
Conversely, OCD patients and controls exhibited
similar amplitudes in ERN and Pe components in pre-
sence of an inferior player. In other words, adopting a
superiority role diminished OCD patients’ ERN signals to
those levels observed in healthy participants. Arguably,
facing an inferior opponent (thus assuming a superior
role) may indeed decrease social anxiety and/or impact
the emotional evaluation of the social context,
10 H. SANTAMARÍA-GARCÍA ET AL.

Figure 4. Social effects on N2 component. The upper panel shows social modulations on the N2 component in the OCD group.
Significant differences were only found when OCD patients performed the task in the presence of superior players (i.e., when OCD
patients were placed in an inferiority position). The central panel shows no significant effects of Hierarchy in controls. For
visualization purposes, the upper and central panels are superimposed in the bottom panel, illustrating the significant Group x
Hierarchy interaction for N2. Squared regions indicate the windows of significant interaction * p < .05.

therefore reducing abnormal error-monitoring pro-
cesses in OCD patients.
Social effects on N2 component
We went one step further by showing that social
effects were not specific to the ERN, but extended
into components indexing cognitive and motor con-
trol. To measure cognitive control we focused on the
frontal N2 component (Folstein & Van Petten, 2008).
We supported previous evidence showing that OCD
patients display lower negativities in the N2 fronto-
central component (see Figure 2), indexing poor cog-
nitive control and conflict adaptation (Folstein & Van
Petten, 2008; Yeung & Cohen, 2006). Importantly,
results also showed social effects on N2 amplitudes
in OCD patients. In particular, OCD patients exhibited
lower N2 amplitudes when performed the task in the
 SOCIAL NEUROSCIENCE 11

Figure 5. Social effects on lateralized readiness potentials. The upper and central panels show the LRP-r waveforms elicited from
patients and controls, respectively. In the patients group, but not in controls, significant differences were found when OCD patients
performed the task in presence of superior players (i.e., when OCD patients were placed in an inferiority position). For visualization
purposes, the bottom panel displays the upper and central panels superimposed, illustrating the significant Group x Hierarchy
interaction *p < .05.

Figure 6. Social effects on participants’ behavioural performance. A main effect of Group was observed for reaction times. A
significant hierarchy effect over participant’s reaction times was observed within the OCD patients group. Error bars represent s.e.m.
Empty star depicts a p < .05.

presence of superior players (i.e., when OCD patients been reported in conditions that evoke anxiety and
assumed an inferiority role) than in the presence of in situations with high requirements of attentional
inferior players (see Figure 4 and Supplementary resources (Folstein and Van Petten 2008; Melloni
Figure 2). Modulations over N2 amplitudes have et al. 2012). In addition, N2 amplitudes have been
12 H. SANTAMARÍA-GARCÍA ET AL.
reported, as reflecting monitoring of cognitive and
emotional conflict (Larson & Clayson, 2011). Those
evidences suggest that OCD patients may present
reduced cognitive and emotional control abilities
when they must assume an inferiority role. Again,
our results support that in OCD patients, the social
sensitivity may impacts a group of core cognitive
processes usually reported as altered in those patients.
It is significant to mention that consistent with our
previous work (Santamaría-García et al., 2013), results
did not revealed effects of social hierarchy over N2
amplitudes in controls. In addition, as it was the case
for the ERN results, it is of note that OCD-specific
amplitudes of frontal N2 in the presence of inferior
players were not significantly different from the N2
amplitudes observed in healthy controls.
Social effects on LRP-r
Regarding our motor control analyses, we observed
larger LRP-r amplitudes in OCD patients vs. controls
during the neutral trials confirming the difficulties in
motor inhibition and motor control mechanisms (larger
LRP-r amplitudes in OCD vs. controls) in these patients
(Johannes et al., 2001). Interestingly, and following the
pattern of results found for ERN/Pe and N2, OCD-spe-
cific social hierarchy modulations on the LRP-r provided
additional information about how social context affects
control mechanisms in patients, extending into motor
preparation and motor control mechanisms. The social
context significantly modulated LRP-r, so that perform-
ing the task in presence of a superior player induced
larger LRP-r signals than performing the task in pre-
sence of an inferior player (see Figure 5 and
Supplementary Figure 2). This effect suggests reduced
motor control and inhibition abilities when the patients
had an inferiority social role with respect to the simu-
lated player. This result can be interpreted in light of
recent evidence demonstrating a tight coupling
between emerging decision variables and preparatory
activation in cortical motor areas (Chamberlain et al.,
2007). Indeed, activity in the pre-supplementary motor
area (pre-SMA) is correlated to the amount of accumu-
lated evidence in decision phases (De Wit et al., 2012;
Gluth, Rieskamp, & Büchel, 2013; Töllner et al., 2012).
Considering those evidences it is possible that in OCD
patients, motor preparation and motor control pro-
cesses are unregulated by enhanced social sensitivity
and emotional pressure associated to have an inferiority
position. This result is in line with the results reported
for ERN, PE and N2 and supports a strong influence of
the social context on the group of sensitive cognitive
processes in OCD patients.
In addition, our results showed that when OCD
patients performed the task in presence of an inferior
player, the LRP-r signals were equivalent to those
observed for controls. Lower LRP-r amplitudes in the
presence of the inferior player could therefore be indi-
cative of decreased accumulation and demands of
motor evidence in a social context where patients had
a higher social position, leading to an increased motor
inhibition process in this context.
Social effects on behavior
At the behavioural level we observed larger group
effects in reaction times. Furthermore, we observed
significant effects of social hierarchy over reaction
times for the OCD group, but not in healthy controls.
OCD patients were slower and less consistent (as mea-
sured by intra-individual variability analyses (see sup-
plementary materials section 1.2) in trials performed
with a superior player than with an inferior player (see
Figure 6). Although behavioural results obtained with
this particular experimental paradigm do not provide
fine-grained information about the main cognitive pro-
cesses of interest (and therefore lack the power of the
ERP approach), they suggest a potential transfer from
the experimental social setting to the actual patient’s
behaviour. Indeed, such findings are reinforced by the
existence of positive correlations between the measure-
ments of the two ERP components (ERN and N2) with
obsessive-compulsive symptom severity.
Our results generate certain considerations that
require further investigation. Although it is true that
previous studies have shown that ERN, N2 and LRP-r
components can be modulated by general mechan-
isms of distress, hyper arousal or trait measurement
such as extraversion or anticipatory pleasure (Fishman
& Ng, 2013), some of our results allow us to support
the notion that our findings are indeed reflecting a
social modulation of core cognitive processes relevant
to OCD. The fact that we did not observe changes in
all ERP components, or in the ERP components more
sensitive to arousal and distress mechanisms (such as
C1, P1, see supplementary materials, section 1.1), indi-
cates that the impact of social context in OCD
patients is not only determined by unspecific changes
in arousal or secondary to general distress mechan-
isms (Di Russo, Martínez, Sereno, Pitzalis, & Hillyard,
2002). By contrast, we observed a selective modula-
tion by social context over the ERP components
related to core cognitive process, namely ERN, PE,
N2 and LRP-r. Moreover, if the ERP results were due
to modulation of unspecific processes related to gen-
eral distress mechanisms and arousal, we should have

observed significant correlations between ERP modu-
lations and general anxiety indicators, such as the
HARS scale (some studies have related the anxiety
states to high levels of arousal and distress, this rela-
tionship has been supported by studies analysing ERP
data, see (Xiao et al., 2011)). Conversely, we have
observed significant correlations between two ERP
components and Y-BOCS scores, suggesting a specific
relationship with obsessive-compulsive symptoms. In
this sense, it is worth highlighting the correlation
between the ERN component and the Y-BOCS score,
since ERN has been considered as a suitable OCD
endophenotype (Riesel et al., 2011), (Olvet & Hajcak,
2008). Therefore, it seems likely that social effects are
indeed modulating the neural mechanisms specifically
related to OCD symptoms, but not interacting with
nonspecific mechanisms of anxiety.
Despite of these considerations, our results present
some limitations. We did not know to what extent
social effects reported in the OCD patients could be
related to the presence of social phobia in this sample.
In fact, previous studies have reported that social pho-
bia and OCD can be simultaneously present in some
subjects (Camuri et al., 2014) (Baldwin, Brandish, &
Meron, 2008). In addition, there are considerable evi-
dences showing that patients with social phobia course
with higher social sensitivity (Boll et al., 2016; Gaebler,
Daniels, Lamke, Fydrich, & Walter, 2013; Veit et al.,
2002). Future studies should explore and control to
what extent in that social effects are related to the
presence of social phobia symptoms. Additional insight
regarding the specificity of social modulations observed
here could be gained by investigating potential effects
over cognitive processes altered in patients with anxi-
ety and depressive disorders.
All in all, we observed that in OCD patients error-
monitoring processes were importantly modulated in
the presence of a social hierarchy. To our knowledge,
this is the first evidence showing social effects on ERN
in a group of patients with disrupted error monitoring
processes. Here we provide novel evidence showing
that the functioning of the error-detection system in
OCD is affected by the presence of a social context,
likely suggesting a modulation of the activity of the
fronto-striatal network by experiencing a social role in
a hierarchy. Furthermore, this effect extends into rele-
vant neuro-markers of cognitive and motor control and
over behavioural measures, particularly over reaction
times. This profile of alterations is consistent with the
sensitivity to social evaluations described in OCD
(Grisham et al., 2010; Pace et al., 2011), and contributes
significantly to our understanding of how the social
environment of OCD patients impacts their core
SOCIAL NEUROSCIENCE 13
cognitive processes. Our results open the door to addi-
tional research on the impact of the social context on
OCD symptoms as well as on therapeutic options based
on the simulation of this kind of social scenarios.
Acknowledgments
This research was supported by grants from the Spanish
Ministerio de Economía y Competitividad (PSI2012-34071),
the Catalan Government (SGR 2009-1521 and SGR 2014
1672) and the Carlos III Health Institute (PI09/01331, PI10/
01753, PI10/01003, CP10/00604, PI13/01958, CIBER-CB06/03/
0034). C. Soriano-Mas is funded by a ‘Miguel Servet’ contract
from the Carlos III Health Institute (CP10/00604). N. Sebastián-
Gallés received the “ICREA Acadèmia” prize for excellence in
research, funded by the Generalitat de Catalunya. Burgaleta
Miguel is funded by Juan de la Cierva grant, code: FPDI-2013-
17528.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This work was supported by the Consejo Superior de
Investigaciones Científicas [PI09/01331, PI10/01753, PI10/
01003, CP10/00604, PI,PSI2012-34071]; Instituto de Salud
Carlos III [CP10/00604,FPDI-2013-17528].
Ethics statement
Permission from the Clinical Research Ethical Committees
(CEICs) was sought and obtained before the individual subjects
were evaluated. A written consent process was used. We
obtained a written consent of each patient and participant.
No participant refused to participate in the study. Since signed
consent forms constitute a possible source of concern for the
protection of respondents’ confidentiality, signatures were col-
lected during the written consent process. The study, including
the written consent process and script, was reviewed and
approved by The Clinical Research Ethical Committees (CEICs)
of the Pompeu Fabra University Barcelona Spain and by the
Ethical Committee of Bellvitge Hospital in Barcelona Spain.
(http://www.imim.es/comitesetics/ceic/en_index.html).
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