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Whether humans adjust their behavior in response to unaware errors remains a controversial issue relevant to insight in neuropsychiatric conditions. Initial error awareness studies found that the error-related negativity (ERN), an event-related potential (ERP) originating in the medial prefrontal cortex after errors, activated equally for aware and unaware errors, suggesting a candidate preconscious mechanism. However, recent studies demonstrate that the ERN decreases after unaware errors. We hypothesized that the ERN is dependent upon awareness, and predicted that previous discrepancies might be due to unaware errors not being differentiated from perceptually uncertain, low-confidence responses that might increase the ERN amplitude. Here we addressed this hypothesis by distinguishing between aware errors, unaware errors, and uncertain responses, and using stimuli (faces) associated with well established sensory ERPs to evaluate the degree of stimulus processing for each trial type. We found that while aware and unaware errors were related to failures at the time of response, uncertain responses were due to failures at the time of stimulus processing indexed by lower amplitude sensory ERPs. Moreover, uncertain responses showed similar ERN activity as aware errors, in comparison with decreased activity for unaware errors. Finally, compared with aware errors, uncertain responses and unaware errors showed reduced neural compensations, such as alpha suppression. Together these findings suggest that the ERN is activated by aware motor errors as well as sensory failures, and that both awareness and certainty are necessary for neural adaptations after errors.

Value-based decisions optimize behavioral outcomes. Because delayed rewards are discounted, an increased tendency to choose smaller, immediate rewards can lead to suboptimal choice. Steep discounting of delayed rewards (impulsivity) characterizes subjects with frontal lobe damage and behavioral disorders including substance abuse. Correspondingly, animal studies and indirect evidence in humans suggest that lower dopamine in the frontal cortex contributes to steeper discounting by impairing corticostriatal function. To test this hypothesis directly, we performed a randomized, double-blind, counterbalanced, placebo-controlled study in which we administered the brain penetrant catechol-O-methyltransferase inhibitor tolcapone or placebo to healthy subjects performing a delay discounting task. Tolcapone significantly increased choice of delayed monetary rewards, and this tolcapone-induced increase covaried with increased BOLD activity in the left ventral putamen and anterior insula. Tolcapone also changed corticostriatal connectivity: specifically, by inducing a decrease in the coherence between ventral putamen and pregenual cingulate cortex. These results indicate that raising cortical dopamine levels attenuates impulsive choice by changing corticostriatal function.