Neural markers of attention to aversive pictures predict response to cognitive behavioral therapy in anxiety and depression

•We evaluated attention toward aversive and neutral target and distracter stimuli.•Event-related potentials (the late positive potential; LPP) were recorded pre-treatment.•Patients received up to 12 sessions of CBT for social anxiety or major depression.•Larger LPPs to aversive distracters (when targets were aversive) predicted treatment response.•CBT may be most beneficial for individuals with attenuated top-down control of attention.

Excessive attention toward aversive information may be a core mechanism underlying emotional disorders, but little is known about whether this is predictive of response to treatments. We evaluated whether enhanced attention toward aversive stimuli, as indexed by an event-related potential component, the late positive potential (LPP), would predict response to cognitive behavioral therapy (CBT) in patients with social anxiety disorder and/or major depressive disorder. Thirty-two patients receiving 12 weeks of CBT responded to briefly-presented pairs of aversive and neutral pictures that served as targets or distracters while electroencephaolography was recorded. Patients with larger pre-treatment LPPs to aversive relative to neutral distracters (when targets were aversive) were more likely to respond to CBT, and demonstrated larger reductions in symptoms of depression and anxiety following treatment. Increased attention toward irrelevant aversive stimuli may signal attenuated top-down control, so treatments like CBT that improve this control could be beneficial for these individuals.