Trait anxiety is an important phenotype in the prediction of stress-induced neuropsychiatric disorders. While the role of trait anxiety in mental effort and cognitive impairment is well documented, much less is known about its influence on motivated behaviors and physical effort. Here, we investigated trait anxiety-related differences in behavioral and neural responses in an effort-related monetary incentive delay task. Participants prompted with different incentive levels could exert handgrip responses to earn monetary rewards while a 256-channel electroencephalography (EEG) was recorded. Participants' performance was linearly dependent on incentive level, with higher stakes prompting better accuracy and higher grip force. Importantly, we found a striking association between trait anxiety and incentive-related grip force; effort exertion was related to incentive level only in high-anxious individuals. In analyses of neural efficiency associated with effort preparation involving Contingent-negative variation (CNV), we found that the CNV amplitude was sensitive to monetary incentive levels. Source imaging analyses of CNV indicated increased activity in the anterior cingulate cortex (ACC) for the highest incentive level. Importantly, we found a significant interaction between trait anxiety and incentive level on CNV modulation at the interval ranging from −2610 to −2510 ms, with greater CNV responses to the lower monetary incentive sizes in high anxiety. Subsequent mediation analyses supported a mediation of the ACC activation on the association between trait anxiety and incentive-selective grip force. Our study reveals a role for ACC in trait anxiety-related differences on incentive processing, when rewards are dependent on effortful performance.