Towards Conceptual Clarification of Proactive Inhibitory Control: A Review.

The aim of this selective review paper is to clarify potential confusion when referring to the term proactive inhibitory control. Illustrated by a concise overview of the literature, we propose defining reactive inhibition as the mechanism underlying stopping an action. On a stop trial, the stop signal initiates the stopping process that races against the ongoing action-related process that is triggered by the go signal. Whichever processes finishes first determines the behavioral outcome of the race. That is, stopping is either successful or unsuccessful in that trial. Conversely, we propose using the term proactive inhibition to explicitly indicate preparatory processes engaged to bias the outcome of the race between stopping and going. More specifically, these proactive processes include either pre-amping the reactive inhibition system (biasing the efficiency of the stopping process) or presetting the action system (biasing the efficiency of the go process). We believe that this distinction helps meaningful comparisons between various outcome measures of proactive inhibitory control that are reported in the literature and extends to experimental research paradigms other than the stop task.

Essential tremor impairs the ability to suppress involuntary action impulses.

Essential tremor (ET) is a movement disorder characterized primarily by action tremor which affects the regulation of movements. Disruptions in cerebello-thalamocortical networks could interfere with cognitive control over actions in ET, for example, the ability to suppress a strong automatic impulse over a more appropriate action (conflict control). The current study investigated whether ET impacts conflict control proficiency. Forty-one ET patients and 29 age-matched healthy controls (HCs) performed a conflict control task (Simon task). Participants were instructed to give a left or right response to a spatially lateralized arrow (direction of the arrow). When the action signaled by the spatial location and direction of the arrow were non-corresponding (induced conflict), the inappropriate action impulse required suppression. Overall, ET patients responded slower and less accurately compared to HCs. ET patients were especially less accurate on non-corresponding conflict (Nc) versus corresponding (Cs) trials. A focused analysis on fast impulsive response rates (based on the accuracy rate at the fastest reaction times on Nc trials) showed that ET patients made more fast errors compared to HCs. Results suggest impaired conflict control in ET compared to HCs. The increased impulsive errors seen in the ET population may be a symptom of deficiencies in the cerebello-thalamocortical networks, or, be caused by indirect effects on the cortico-striatal pathways. Future studies into the functional networks impacted by ET (cortico-striatal and cerebello-thalamocortical pathways) could advance our understanding of inhibitory control in general and the cognitive deficits in ET.

Deep-brain stimulation of the subthalamic nucleus improves overriding motor actions in Parkinson's disease.

Findings from previous research using the classic stop-signal task indicate that the subthalamic nucleus (STN) plays an important role in the ability to inhibit motor actions. Here we extend these findings using a stop-change task that requires voluntary action override to stop an ongoing motor response and change to an alternative response. Sixteen patients diagnosed with Parkinson's disease (PD) and 16 healthy control participants (HC) performed the stop-change task. PD patients completed the task when deep-brain stimulation (DBS) of the STN was turned on and when it was turned off. Behavioral results indicated that going, stopping, and changing latencies were shortened significantly among PD patients during STN DBS, the former two reductions replicating findings from previous DBS studies using the classic stop-signal task. The shortened go latencies observed among PD patients fell within the control range. In contrast, stopping latencies among PD patients, although reduced significantly, continued to be significantly longer than those of the HC. Like go latencies, stop-change latencies were reduced sufficiently among PD patients for them to fall within the control range, a novel finding. In conclusion, STN DBS produced a general, but differential, improvement in the ability of PD patients to override motor actions. Going, stopping, and stop-change latencies were all shortened, but only going and stop-change latencies were normalized.

Moderate acute alcohol use impairs intentional inhibition rather than stimulus-driven inhibition.

Moderate alcohol intake may impair stimulus-driven inhibition of motor actions in go/no-go and stop-signal tasks. Exposure to alcohol-related cues has been found to exacerbate this impairment. By contrast, the effect of alcohol use on intentional inhibition, or the capacity to voluntarily suspend an action, has rarely been investigated. We examined whether and how moderate alcohol intake affects stimulus-driven inhibition (stop-signal task) and intentional inhibition (chasing bottles task), during exposure to alcohol-related stimuli. One hundred and eleven participants were randomly assigned to an alcohol (male: 0.55 g/kg, female: 0.45 g/kg), placebo, or control group. For the stop-signal task, ANOVAs were performed on stop-signal reaction time (SSRT) and go RT with Pharmacological and Expectancy Effects of Alcohol, Stimulus Category (alcohol-related or neutral), and Sex as factors. For the chasing bottles task, multilevel survival analysis was performed to predict whether and when intentional inhibition was initiated, with the same factors. For the stop-signal task, Sex moderated the Pharmacological Effect of Alcohol on SSRT: only for females, alcohol consumption shortened SSRT. In the non-alcohol groups, males had shorter SSRT than females. Concerning intentional inhibition, the alcohol group initiated intentional inhibition less often, especially when stimuli were non-alcohol related. These findings indicate that (1) stimulus-driven inhibition and intentional inhibition reflect different aspects of response inhibition; (2) moderate alcohol intake negatively affects intentional inhibition (but not stimulus-driven inhibition). Speculatively, the observed impairment in intentional inhibition might underlie the lack of control over alcohol drinking behavior after a priming dose. This study highlights the potential role of intentional inhibition in the development of addiction.

The arrow of time: Advancing insights into action control from the arrow version of the Eriksen flanker task.

Since its introduction by B. A. Eriksen and C. W. Eriksen (Perception & Psychophysics, 16, 143-49, 1974), the flanker task has emerged as one of the most important experimental tasks in the history of cognitive psychology. The impact of a seemingly simple task design involving a target stimulus flanked on each side by a few task-irrelevant stimuli is astounding. It has inspired research across the fields of cognitive neuroscience, psychophysiology, neurology, psychiatry, and sports science. In our tribute to Charles W. ("Erik") Eriksen, we (1) review the seminal papers originating from his lab in the 1970s that launched the paradigmatic task and laid the foundation for studies of action control, (2) describe the inception of the arrow version of the Eriksen flanker task, (3) articulate the conceptual and neural models of action control that emerged from studies of the arrows flanker task, and (4) illustrate the influential role of the arrows flanker task in disclosing developmental trends in action control, fundamental deficits in action control due to neuropsychiatric disorders, and enhanced action control among elite athletes.

Subthalamic Nucleus Subregion Stimulation Modulates Inhibitory Control.

Patients with Parkinson's disease (PD) often experience reductions in the proficiency to inhibit actions. The motor symptoms of PD can be effectively treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN), a key structure in the frontal-striatal network that may be directly involved in regulating inhibitory control. However, the precise role of the STN in stopping control is unclear. The STN consists of functional subterritories linked to dissociable cortical networks, although the boundaries of the subregions are still under debate. We investigated whether stimulating the dorsal and ventral subregions of the STN would show dissociable effects on ability to stop. We studied 12 PD patients with STN DBS. Patients with two adjacent contacts positioned within the bounds of the dorsal and ventral STN completed two testing sessions (OFF medication) with low amplitude stimulation (0.4 mA) at either the dorsal or ventral contacts bilaterally, while performing the stop task. Ventral, but not dorsal, DBS improved stopping latencies. Go reactions were similar between dorsal and ventral DBS STN. Stimulation in the ventral, but not dorsal, subregion of the STN improved stopping speed, confirming the involvement of the STN in stopping control and supporting the STN functional subregions.

"Free won't" after a beer or two: chronic and acute effects of alcohol on neural and behavioral indices of intentional inhibition.

BACKGROUND: Response inhibition can be classified into stimulus-driven inhibition and intentional inhibition based on the degree of endogenous volition involved. In the past decades, abundant research efforts to study the effects of alcohol on inhibition have focused exclusively on stimulus-driven inhibition. The novel Chasing Memo task measures stimulus-driven and intentional inhibition within the same paradigm. Combined with the stop-signal task, we investigated how alcohol use affects behavioral and psychophysiological correlates of intentional inhibition, as well as stimulus-driven inhibition. METHODS: Experiment I focused on intentional inhibition and stimulus-driven inhibition in relation to past-year alcohol use. The Chasing Memo task, the stop-signal task, and questionnaires related to substance use and impulsivity were administered to 60 undergraduate students (18-25 years old). Experiment II focused on behavioral and neural correlates acute alcohol use on performance on the Chasing Memo task by means of electroencephalography (EEG). Sixteen young male adults (21-28 years old) performed the Chasing Memo task once under placebo and once under the influence of alcohol (blood alcohol concentration around 0.05%), while EEG was recorded. RESULTS: In experiment I, AUDIT (Alcohol Use Disorder Identification Test) total score did not significantly predict stimulus-driven inhibition or intentional inhibition performance. In experiment II, the placebo condition and the alcohol condition were comparable in terms of behavioral indices of stimulus-driven inhibition and intentional inhibition as well as task-related EEG patterns. Interestingly, a slow negative readiness potential (RP) was observed with an onset of about 1.2 s, exclusively before participants stopped intentionally. CONCLUSIONS: These findings suggest that both past-year increases in risky alcohol consumption and moderate acute alcohol use have limited effects on stimulus-driven inhibition and intentional inhibition. These conclusions cannot be generalized to alcohol use disorder and high intoxication levels. The RP might reflect processes involved in the formation of an intention in general.

Is (poly-) substance use associated with impaired inhibitory control? A mega-analysis controlling for confounders.

Many studies have reported that heavy substance use is associated with impaired response inhibition. Studies typically focused on associations with a single substance, while polysubstance use is common. Further, most studies compared heavy users with light/non-users, though substance use occurs along a continuum. The current mega-analysis accounted for these issues by aggregating individual data from 43 studies (3610 adult participants) that used the Go/No-Go (GNG) or Stop-signal task (SST) to assess inhibition among mostly "recreational" substance users (i.e., the rate of substance use disorders was low). Main and interaction effects of substance use, demographics, and task-characteristics were entered in a linear mixed model. Contrary to many studies and reviews in the field, we found that only lifetime cannabis use was associated with impaired response inhibition in the SST. An interaction effect was also observed: the relationship between tobacco use and response inhibition (in the SST) differed between cannabis users and non-users, with a negative association between tobacco use and inhibition in the cannabis non-users. In addition, participants' age, education level, and some task characteristics influenced inhibition outcomes. Overall, we found limited support for impaired inhibition among substance users when controlling for demographics and task-characteristics.

Exposing an "Intangible" Cognitive Skill Among Collegiate Football Players: III. Enhanced Reaction Control to Motion.

Football is played in a dynamic, often unpredictable, visual environment in which players are challenged to process and respond with speed and flexibility to critical incoming stimulus events. To meet this challenge, we hypothesize that football players possess, in conjunction with their extraordinary physical skills, exceptionally proficient executive cognitive control systems that optimize response execution. It is particularly important for these systems to be proficient at coordinating directional reaction and counter-reaction decisions to the very rapid lateral movements routinely made by their opponents during a game. Despite the importance of this executive skill to successful on-field performance, it has not been studied in football players. To fill this void, we compared the performances of Division I college football players (n = 525) and their non-athlete age counterparts (n = 40) in a motion-based stimulus-response compatibility task that assessed their proficiency at executing either compatible (in the same direction) or incompatible (in the opposite direction) lateralized reactions to a target's lateral motion. We added an element of decision uncertainty and complexity by giving them either sufficient or insufficient time to preload the response decision rule (i.e., compatible vs. incompatible) prior to the target setting in motion. Overall, football players were significantly faster than non-athlete controls in their choice reactions to a target's lateral motion. The reactions of all participants slowed when issuing incompatible counter-reactions to a target's lateral motion. For football players, this cost was reduced substantially compared to controls when given insufficient time to preload the decision rule, indicating that they exerted more efficient executive control over their reactions and counter-reactions when faced with decision uncertainty at the onset of stimulus motion. We consider putative sources of their advantage in reacting to a target's lateral motion and discuss how these findings advance the hypothesis that football players utilize highly-proficient executive control systems to overcome processing conflicts during motor performance.

Action Control Deficits in Patients With Essential Tremor.

OBJECTIVES: Essential tremor (ET) is a movement disorder characterized by action tremor which impacts motor execution. Given the disrupted cerebellar-thalamo-cortical networks in ET, we hypothesized that ET could interfere with the control mechanisms involved in regulating motor performance. The ability to inhibit or stop actions is critical for navigating many daily life situations such as driving or social interactions. The current study investigated the speed of action initiation and two forms of action control, response stopping and proactive slowing in ET. METHODS: Thirty-three ET patients and 25 healthy controls (HCs) completed a choice reaction task and a stop-signal task, and measures of going speed, proactive slowing and stop latencies were assessed. RESULTS: Going speed was significantly slower in ET patients (649 ms) compared to HCs (526 ms; F(1,56) = 42.37; p <.001; η 2 = .43), whereas proactive slowing did not differ between groups. ET patients exhibited slower stop signal reaction times (320 ms) compared to HCs (258 ms, F(1,56) = 15.3; p <.00; η 2 = .22) and more severe motor symptoms of ET were associated with longer stopping latencies in a subset of patients (Spearman rho = .48; p <.05). CONCLUSIONS: In line with previous studies, ET patients showed slower action initiation. Additionally, inhibitory control was impaired whereas proactive slowing remained intact relative to HCs. More severe motor symptoms of ET were associated with slower stopping speed, and may reflect more progressive changes to the cerebellar-thalamo-cortical network. Future imaging studies should specify which structural and functional changes in ET can explain changes in inhibitory action control. (JINS, 2019, 25, 156-164).

Exposing an "Intangible" Cognitive Skill Among Collegiate Football Players: II. Enhanced Response Impulse Control.

American football is played in a dynamic environment that places considerable demands on a player's ability to make fast, precise reactions while controlling premature, impulsive reactions to spatial misinformation. We investigated the hypothesis that collegiate football players are more proficient than their non-athlete counterparts at controlling impulsive motor actions. National Collegiate Athletic Association (NCAA) Division I football players (n = 280) and non-athlete controls (n = 32) completed a variant of the Simon conflict task, which quantifies choice reaction speed and the proficiency of controlling spatially driven response impulses. Overall, the choice reaction times (RTs) and accuracy rates of football players and controls were equivalent. Similarly, football players and controls were equally susceptible to producing incorrect impulsive motor responses. However, the slowing of RT attributed to the activation and successful inhibition of these impulses (i.e., the Simon effect) was reduced significantly among football players compared to controls. Moreover, differences in impulse control varied by position among the players, with the reduction being greater for offensive than for defensive players. Among offensive players, running backs, wide receivers, and offensive linemen had greater impulse control than did controls, whereas among defensive players only linebackers had greater control. Notably, the Simon effect was reduced by 60% in running backs compared to controls. These results contribute to emerging evidence that elite football players possess more proficient executive control over their motor systems than their age counterparts and suggest that the speed of controlling impulsive motor reactions may represent an enhanced cognitive "intangible" among football players.

Repetitive transcranial magnetic stimulation over inferior frontal cortex impairs the suppression (but not expression) of action impulses during action conflict.

In the recent literature, the effects of noninvasive neurostimulation on cognitive functioning appear to lack consistency and replicability. We propose that such effects may be concealed unless dedicated, sensitive, and process-specific dependent measures are used. The expression and subsequent suppression of response capture are often studied using conflict tasks. Response-time distribution analyses have been argued to provide specific measures of the susceptibility to make fast impulsive response errors, as well as the proficiency of the selective suppression of these impulses. These measures of response capture and response inhibition are particularly sensitive to experimental manipulations and clinical deficiencies that are typically obfuscated in commonly used overall performance analyses. Recent work using structural and functional imaging techniques links these behavioral outcome measures to the integrity of frontostriatal networks. These studies suggest that the presupplementary motor area (pre-SMA) is linked to the susceptibility to response capture whereas the right inferior frontal cortex (rIFC) is associated with the selective suppression of action impulses. Here, we used repetitive transcranial magnetic stimulation (rTMS) to test the causal involvement of these two cortical areas in response capture and inhibition in the Simon task. Disruption of rIFC function specifically impaired selective suppression of conflicting action tendencies, whereas the anticipated increase of fast impulsive errors after perturbing pre-SMA function was not confirmed. These results provide a proof of principle of the notion that the selection of appropriate dependent measures is perhaps crucial to establish the effects of neurostimulation on specific cognitive functions.

Dopaminergic medication shifts the balance between going and stopping in Parkinson's disease.

The present behavioral study delineates the impact of Parkinson's disease (PD) and of dopaminergic medication on action control over voluntary behavior. Previous studies reported either prolonged responding or stopping latencies in PD compared to healthy controls (HC). Few studies investigated the effects of dopaminergic medication on these processes concurrently. We administered a stop-change task, an extended version of the stop task, that required (i) speeded responding to a go signal (i.e., going), (ii) inhibiting ongoing motor responses (i.e., stopping), and (iii) changing to an alternative response. PD performance (n = 33) was collected once during regular dopaminergic medication conditions (On state) and once after a medication washout period (Off state). A group of age-matched HC (n = 21) performed the stop-change task once. Response latencies to go signals were comparable between HC and PD Off, indicative of unimpaired going. Compared to HC, PD Off showed prolonged stopping latencies. Within the clinical group, stopping latencies significantly improved after taking dopaminergic medication. Interestingly, the shorter stopping latencies observed in the On state were paralleled by longer response latencies to go signals. The degree of the inhibition improvement observed in the medication state was correlated with the degree of response slowing. Change RT did not vary between groups or between medication states. These patterns of results are discussed in terms of a tradeoff between going versus stopping of motor responses in PD patients. Shifts of this tradeoff seem to be driven by dopaminergic medication, which has potential clinical implications.

Overriding actions in Parkinson's disease: Impaired stopping and changing of motor responses.

We administered a stop-change paradigm, an extended version of the stop task that requires (a) stopping an ongoing motor response and (b) changing to an alternative (change) response. Performance of a group of patients diagnosed with Parkinson's disease (PD) and taking dopaminergic medication was compared with that of matched healthy control (HC) participants. Behavioral results indicated that response latencies to the initial go signal did not distinguish between the 2 groups, but that stopping latencies were prolonged in PD patients. In addition, the change response was delayed in the clinical group, indicating difficulties in flexibly changing to alternative motor actions upon external cues. The change deficit in PD related to the inhibition deficit. This dependence points to a serial processing architecture in PD according to which the stopping process has to finish before the change process can be initiated. In contrast, the HC group showed parallel stop and change processing. Analyses of sequential trial effects suggest that both HC and PD patients are susceptible to aftereffects of action override, due to the consequences of the automatic retrieval of recent associations between action and goal representations. Interestingly, postchange performance of the clinical group was hampered disproportionately, suggesting that PD is associated with an impairment in overriding previously formed action-goal associations. These findings support the notion that both higher-order cognitive control processes, such as inhibiting and changing actions, as well as lower-order feature binding mechanisms rely on basal ganglia functioning and are compromised by the basal ganglia dysfunction caused by PD. (PsycINFO Database Record

Time-on-task effects in children with and without ADHD: depletion of executive resources or depletion of motivation?

Children with attention-deficit/hyperactivity disorder (ADHD) are characterized by deficits in their executive functioning and motivation. In addition, these children are characterized by a decline in performance as time-on-task increases (i.e., time-on-task effects). However, it is unknown whether these time-on-task effects should be attributed to deficits in executive functioning or to deficits in motivation. Some studies in typically developing (TD) adults indicated that time-on-task effects should be interpreted as depletion of executive resources, but other studies suggested that they represent depletion of motivation. We, therefore, investigated, in children with and without ADHD, whether there were time-on-task effects on executive functions, such as inhibition and (in)attention, and whether these were best explained by depletion of executive resources or depletion of motivation. The stop-signal task (SST), which generates both indices of inhibition (stop-signal reaction time) and attention (reaction time variability and errors), was administered in 96 children (42 ADHD, 54 TD controls; aged 9-13). To differentiate between depletion of resources and depletion of motivation, the SST was administered twice. Half of the participants was reinforced during second task performance, potentially counteracting depletion of motivation. Multilevel analyses indicated that children with ADHD were more affected by time-on-task than controls on two measures of inattention, but not on inhibition. In the ADHD group, reinforcement only improved performance on one index of attention (i.e., reaction time variability). The current findings suggest that time-on-task effects in children with ADHD occur specifically in the attentional domain, and seem to originate in both depletion of executive resources and depletion of motivation. Clinical implications for diagnostics, psycho-education, and intervention are discussed.

Stopping Manual and Vocal Actions in Tourette's Syndrome.

Evidence that Tourette's syndrome (TS) disrupts inhibitory motor control is highly mixed. The authors investigated inhibitory control of manual and vocal actions in young adults with relatively uncomplicated, persistent TS. Both TS and control groups showed similar response latencies when executing manual and vocal reactions, but individuals with TS were slower at stopping their manual and vocal responses. While alterations in inhibitory motor control may not be a generalizable phenomenon in TS, these results add to an emerging literature suggesting that individuals with relatively uncomplicated TS, whose symptoms persist into adulthood, show disruption to inhibitory control mechanisms.

Preventing (impulsive) errors: Electrophysiological evidence for online inhibitory control over incorrect responses.

In a rich environment, with multiple action affordances, selective action inhibition is critical in preventing the execution of inappropriate responses. Here, we studied the origin and the dynamics of incorrect response inhibition and how it can be modulated by task demands. We used EEG in a conflict task where the probability of compatible and incompatible trials was varied. This allowed us to modulate the strength of the prepotent response, and hence to increase the risk of errors, while keeping the probability of the two responses equal. The correct response activation and execution was not affected by compatibility or by probability. In contrast, incorrect response inhibition in the primary motor cortex ipsilateral to the correct response was more pronounced on incompatible trials, especially in the condition where most of the trials were compatible, indicating a modulation of inhibitory strength within the course of the action. Two prefrontal activities, one medial and one lateral, were also observed before the response, and their potential links with the observed inhibitory pattern observed are discussed.

The effect of aging on fronto-striatal reactive and proactive inhibitory control.

Inhibitory control, like most cognitive processes, is subject to an age-related decline. The effect of age on neurofunctional inhibition processing remains uncertain, with age-related increases as well as decreases in activation being reported. This is possibly because reactive (i.e., outright stopping) and proactive inhibition (i.e., anticipation of stopping) have not been evaluated separately. Here, we investigate the effects of aging on reactive as well as proactive inhibition, using functional MRI in 73 healthy subjects aged 30-70years. We found reactive inhibition to slow down with advancing age, which was paralleled by increased activation in the motor cortex. Behaviorally, older adults did not exercise increased proactive inhibition strategies compared to younger adults. However, the pattern of activation in the right inferior frontal gyrus (rIFG) showed a clear age-effect on proactive inhibition: rather than flexibly engaging the rIFG in response to varying stop-signal probabilities, older subjects showed an overall hyperactivation. Whole-brain analyses revealed similar hyperactivations in various other frontal and parietal brain regions. These results are in line with the neural compensation hypothesis of aging: processing becomes less flexible and efficient with advancing age, which is compensated for by overall enhanced activation. Moreover, by disentangling reactive and proactive inhibition, we can show for the first time that the age-related increase in activation during inhibition that is reported generally by prior studies may be the result of compensation for reduced neural flexibility related to proactive control strategies.

Dissociable Effects of Dopamine on the Initial Capture and the Reactive Inhibition of Impulsive Actions in Parkinson's Disease.

Dopamine plays a key role in a range of action control processes. Here, we investigate how dopamine depletion caused by Parkinson disease (PD) and how dopamine restoring medication modulate the expression and suppression of unintended action impulses. Fifty-five PD patients and 56 healthy controls (HCs) performed an action control task (Simon task). PD patients completed the task twice, once withdrawn from dopamine medications and once while taking their medications. PD patients experienced similar susceptibility to making fast errors in conflict trials as HCs, but PD patients were less proficient compared with HCs at suppressing incorrect responses. Administration of dopaminergic medications had no effect on impulsive error rates but significantly improved the proficiency of inhibitory control in PD patients. We found no evidence that dopamine precursors and agonists affected action control in PD differently. Additionally, there was no clear evidence that individual differences in baseline action control (off dopamine medications) differentially responded to dopamine medications (i.e., no evidence for an inverted U-shaped performance curve). Together, these results indicate that dopamine depletion and restoration therapies directly modulate the reactive inhibitory control processes engaged to suppress interference from the spontaneously activated response impulses but exert no effect on an individual's susceptibility to act on impulses.

Increasing the role of belief information in moral judgments by stimulating the right temporoparietal junction.

Morality plays a vital role in our social life. A vast body of research has suggested that moral judgments rely on cognitive processes mediated by the right temporoparietal junction (rTPJ), an area thought to be involved in belief attribution. Here we assessed the role of the rTPJ in moral judgments directly by means of transcranial direct current stimulation (tDCS)--a non-invasive brain stimulation technique that, by applying a weak current to the scalp, allows modulating cortical excitability of the area being stimulated. Participants were randomly and equally assigned to receive anodal stimulation (to increase cortical excitability), cathodal stimulation (to decrease cortical excitability), or sham (placebo) stimulation over the rTPJ before completing a moral judgment task. Participants read stories in which protagonists produced either a negative or a neutral outcome based on either a negative or a neutral belief that they were causing harm or no harm, respectively. Results revealed a selective group difference when judging the moral permissibility of accidental harms (belief neutral, outcome negative), but not intentional harms (belief negative, outcome negative), attempted harms (belief negative, outcome neutral), or neutral acts (belief neutral, outcome neutral). Specifically, participants who received anodal stimulation assigned less blame to accidental harms compared to participants who received cathodal or sham stimulation. These results are consistent with previous findings showing that the degree of rTPJ activation reflects reliance on the agent's innocent intention. Crucially, our findings provide direct evidence supporting the critical role of the rTPJ in mediating belief attribution for moral judgment.