Transcutanenous auricular vagus nerve stimulation affects sustained attention in an order-dependent manner

Wienke, Christian; Woller, Joshua P.; Zuberer, Agnieszka; Gharabaghi, Alireza; Zaehle, Tino · 2025 · Crossref

DOI: 10.1101/2025.10.07.680948

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Summary

This study investigates the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on sustained attention, specifically examining whether stimulation timing and order influence behavioral and electrophysiological outcomes. Sustained attention relies on the Locus coeruleus-Noradrenaline (LC-NA) system, which taVNS can modulate via the auricular branch of the vagus nerve. While previous research has explored taVNS in various paradigms, its impact on the gradual-onset Continuous Performance Task (gradCPT)—a measure of sustained attention that minimizes exogenous attentional capture—remains underexplored, particularly regarding electrophysiological markers and the confounding variable of stimulation order. The researchers employed a single-blind, within-subject, counterbalanced design with 44 healthy participants. Subjects performed the gradCPT across two sessions separated by at least 24 hours, receiving either active taVNS or sham stimulation in a pseudorandomized order. During the task, participants responded to frequent "Go" stimuli (city scenes) and withheld responses to infrequent "Nogo" stimuli (mountain scenes). taVNS or sham stimulation was delivered as 500 ms trains of 30 Hz pulses time-locked to each stimulus onset. Electroencephalography (EEG) was recorded throughout to analyze event-related potentials (ERPs), specifically fronto-central P1-N1 and parietal N1-P2 components. Behavioral metrics included reaction times (RTs), RT variability, and discriminatory ability. Data were analyzed using linear and generalized linear mixed models. The results demonstrated that taVNS effects were strictly order-dependent. When taVNS was administered during the first session, it accelerated reaction times and enhanced fronto-central P1-N1 and parietal N1-P2 amplitudes. Larger P1-N1 amplitudes were predictive of faster responses, linking early cortical gain to improved behavioral performance. Notably, these RT improvements persisted into the subsequent sham session, indicating a carryover effect. Conversely, when taVNS was applied only during the second session—after participants were familiar with the task—it was ineffective. Additionally, taVNS increased reaction time variability, suggesting it does not uniformly improve response automation. No significant differences were found in adverse effects or subjective mind-wandering reports between conditions. These findings indicate that taVNS modulates sustained attention mechanisms, but its efficacy is contingent on the novelty of the task context. The lack of effect in the second session suggests that taVNS may primarily facilitate attentional engagement during initial learning or high-demand phases rather than enhancing automated performance. The study highlights critical methodological implications for future taVNS research, emphasizing the necessity of counterbalancing stimulation order to avoid confounding results with learning or habituation effects.

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• neuro workload indices