Moderate-to-severe traumatic brain injury (M/S TBI) is a growing public health concern with significant impact on the cognitive functioning of survivors. Cognitive control and deficits in awareness have been linked to poor recovery and rehabilitation outcomes. One way to research cognitive control is through awareness of errors using electroencephalogram and event-related potentials (ERPs). Both the error-related negativity and the post-error positivity components of the ERP are linked to error awareness and cognitive control processes. Attentional capacity and levels of apathy influence error awareness in those with M/S TBI. There are strong links between awareness, attention, and apathy. However, limited research has examined the role of attention, awareness, and apathy using electrophysiological indices of error awareness to further understand cognitive control in a M/S TBI sample. The current study sought to elucidate the role of apathy in error awareness in those with M/S TBI. Participants included 75 neurologically-healthy controls (divided randomly into two control groups) and 24 individuals with M/S TBI. All participants completed self-report measures of mood, apathy, and executive functioning, as well as a brief neuropsychological battery to measure attention and cognitive ability. To measure awareness, participants completed the error awareness task (EAT), a modified Stroop go/no-go task. Participants signaled awareness of errors committed on the previous trial. The M/S TBI group decreased accuracy while improving or maintaining error awareness compared to controls over time. There were no significant between-group differences for ERN and Pe amplitudes. Levels of apathy in the M/S TBI group were included in three multiple regression analyses predicting proportion of unaware errors, ERN amplitude, and Pe amplitude. Apathy was predictive of error awareness, although not in the predicted direction. Major analyses were replicated using two distinct control groups to determine potential sample effects. Results showed consistent results comparing both control groups to a M/S TBI group. Findings show variable levels of awareness and accuracy over time for those with M/S TBI when compared to controls. Conclusions include varying levels of attention and awareness from the M/S TBI group over time, evidenced by improving awareness of errors when they are happening, but an inability to regulate performance sufficiently to improve accuracy. Levels of apathy are playing a role in error awareness, however, not in predicted directions. The study provides support for the role of attentional impairments in error awareness and encourages future studies to look for varying levels of performance within a given task when using populations linked to elevated levels of apathy and attentional deficits.



College and Department

Family, Home, and Social Sciences; Psychology



Date Submitted


Document Type





traumatic brain injury (TBI), apathy, cognitive control, event-related potential (ERP), error-related negativity (ERN), post-error positivity (Pe), error awareness task (EAT)



Included in

Psychology Commons