Emotion regulation in depression: Examining the role of cognitive processes

Sustained negative affect is a hallmark feature of depressive episodes. The ability to regulate emotional responses to negative events may therefore play a critical role in our understanding of this debilitating disorder. Individual differences in cognitive processes such as attention, memory, and interpretation may underlie difficulties in emotion regulation and numerous studies have identified cognitive biases and deficits that characterise depressed people. Few studies, however, have explicitly linked these biases to the difficulties in emotion regulation that are associated with depression. In this paper we discuss relations among cognitive processes and emotion regulation and review the depression literature to identify cognitive biases and deficits that may underlie maladaptive responses to negative events and mood states. Our review suggests that difficulties in the disengagement from negative material, memory biases, and deficits in cognitive control are frequently observed in depressive disorders and may be associated with the use of maladaptive emotion regulation strategies, such as rumination. These biases may also be related to difficulties implementing strategies that are effective for non-depressed people, such as recall of mood-incongruent material and reappraisal. Our review also suggests, however, that empirical studies linking cognitive biases and emotion regulation in depression are still largely missing and would present an important goal for future research in this area.     

Mapping the interplay among cognitive biases,emotion regulation,and depressive symptoms

Cognitive biases and emotion regulation (ER) difficulties have been instrumental in understanding hallmark features of depression. However, little is known about the interplay among these important risk factors to depression. This cross-sectional study investigated how multiple cognitive biases modulate the habitual use of ER processes and how ER habits subsequently regulate depressive symptoms. All participants first executed a computerised version of the scrambled sentences test (interpretation bias measure) while their eye movements were registered (attention bias measure) and then completed questionnaires assessing positive reappraisal, brooding, and depressive symptoms. Path and bootstrapping analyses supported both direct effects of cognitive biases on depressive symptoms and indirect effects via the use of brooding and via the use of reappraisal that was in turn related to the use of brooding. These findings help to formulate a better understanding of how cognitive biases and ER habits interact to maintain depressive symptoms.     

Cognitive biases in three prediction tasks: A test of the cognitive model of depression

Cognitive therapy for depression is based on an assumption that depressed individuals have inaccurate, negative biases. Whether this assumption is accurate remains unresolved. Thus, this study sought to examine the relationship between depressive symptoms and bias in three sets of predictions (i.e., predictions of future life events, how one would be rated by a significant other, and performance on a vocabulary test). Following study announcements made to a subset of people pre-screened for depressive symptoms, 85 participants with widely varying depressive symptoms (17 of whom met diagnostic criteria for depression) made predictions on three judgment tasks and the outcomes for these tasks were assessed. Optimistic/pessimistic biases were related to depressive symptoms for each of the three tasks. Participants with high levels of depressive symptoms and depressed participants exhibited substantial pessimistic bias. Those high in depressive symptoms exhibited significant pessimistic bias on all three tasks. Participants meeting diagnostic criteria for depression exhibited pessimistic bias on two of three tasks. There was no evidence that depressive symptoms were associated with greater accuracy in judgments. Results are largely consistent with cognitive models of depression which postulate that depression is associated with pessimistic biases.     

A review of cognitive biases in youth depression: attention,interpretation and memory

Depression is one of the most common mental health problems in childhood and adolescence. Although data consistently show it is associated with self-reported negative cognitive styles, less is known about the mechanisms underlying this relationship. Cognitive biases in attention, interpretation and memory represent plausible mechanisms and are known to characterise adult depression. We provide the first structured review of studies investigating the nature and causal role of cognitive biases in youth depression. Key questions are (i) do cognitive biases characterise youth depression? (ii) are cognitive biases a vulnerability factor for youth depression? and (iii) do cognitive biases play a causal role in youth depression? We find consistent evidence for positive associations between attention and interpretation biases and youth depression. Stronger biases in youth with an elevated risk of depression support cognitive-vulnerability models. Preliminary evidence from cognitive bias modification paradigms supports a causal role of attention and interpretation biases in youth depression but these paradigms require testing in clinical samples before they can be considered treatment tools. Studies of memory biases in youth samples have produced mixed findings and none have investigated the causal role of memory bias. We identify numerous areas for future research in this emerging field.     

Attention bias in youth: Associations with youth and mother's depressive symptoms moderated by emotion regulation and affective dynamics during family interactions

Recent research has highlighted the potential role of attention bias for emotional stimuli as a possible cognitive risk factor for depression in youth. However, differences in youth emotion regulation or maternal affect may moderate the association between maternal and youth depression and youth attention biases. The current study investigated the relationship between maternal and youth depressive symptoms and youth (aged 11–17 years) attention bias for sad and happy faces in 59 mother–youth dyads, examining whether positive and negative maternal affect observed during structured interaction tasks or youth emotion regulation tendencies moderated associations between maternal and youth depression and attention biases. Youth suppression interacted with maternal and youth depression to predict sad attentional biases in youth, while maternal positive affect interacted with maternal depression to predict happy attention biases in youth.     

抑郁症患者工作记忆内情绪刺激加工的特点及其机制

抑郁症患者在工作记忆内情绪刺激加工的特点为倾向于加工与负性心境一致的材料, 被认为是抑郁症认知易感性的核心特征。目前研究者们围绕抑郁症工作记忆中央执行系统三个子功能的情绪刺激加工特点及其作用机制进行了大量研究, 发现在更新功能上, 患者难以移除负性情绪信息, 且在正性信息的加工上存在缺损; 在抑制功能上, 患者难以抑制无关负性情绪信息进入工作记忆; 在转换功能上, 患者情绪材料转换困难的研究证据尚不充分。神经生理与脑成像的研究初步表明, 工作记忆中的情绪刺激加工与抑郁症患者背外侧前额叶和前扣带回的功能激活水平异常有关。未来研究需评估工作记忆三个子功能对抑郁症状的差异性贡献及在情绪刺激加工上的统一性, 并探究其随疾病发生发展变化的轨迹, 谨慎选取并评估不同情绪刺激材料指标的诱发效应及其对工作记忆功能的独特影响。在此基础上, 深入探究工作记忆内情绪刺激加工的神经机制, 为工作记忆偏向矫正干预的临床应用及其预期效果提供理论依据和方向。     

The indirect effect of attention bias on memory via interpretation bias: Evidence for the combined cognitive bias hypothesis in subclinical depression

Little research has investigated functional relations among attention, interpretation, and memory biases in depressed samples. The present study tested the indirect effect of attention bias on memory through interpretation bias as an intervening variable in a mixed sample of non-depressed and subclinically depressed individuals. Subclinically depressed and non-depressed individuals completed a spatial cueing task (to measure attention bias), followed by a scrambled sentences test (to measure interpretation bias), and an incidental free recall task (to measure memory bias). Bias-corrected bootstrapping yielded evidence for the hypothesised indirect effect model, in that an emotional bias in attention is related to a congruent bias in interpretative choices which are in turn reflected in memory. These findings extend previous research and provide further support for the combined cognitive bias hypothesis in depression. Theoretical and clinical implications of our findings are discussed.     

A Single-Session Online Cognitive Bias Modification of Interpretations Modified for Adults With Anxiety and Depressive Symptoms

Anxiety and depression are common, co-occurring, and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression—interpretation bias and attribution style—in adults with varying levels of anxiety and depressive symptoms. Participants (18–26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at posttraining and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to posttraining were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.     

Negative interpretation bias as a mechanism of the relationship between rejection sensitivity and depressive symptoms

Rejection sensitivity and negative cognitive biases have been identified as important risk factors for depression. Rejection sensitivity is defined as the tendency to anxiously anticipate, easily perceive, and overreact to rejection. Although prior studies have found an association between one component of rejection sensitivity, the tendency to anxiously anticipate rejection, and depression, little is known about the mechanisms through which anxious anticipation of rejection might confer depression risk. One possibility is that rejection anticipation leads to negatively biased interpretations, a cognitive risk factor for depression. Results from two studies (one cross-sectional, one longitudinal) indicate that negative interpretation biases mediate the association between the anxious anticipation of rejection and depressive symptoms. These findings indicate that interpretation biases represent a mechanism through which anxious anticipation of rejection confers risk for depression, and suggest that interventions designed to challenge negative interpretations may help to decrease depression risk among individuals who anticipate rejection.     

Threat-based cognitive biases in anxious children: comparison with non-anxious children before and after cognitive behavioural treatment

Attention and interpretation biases for threat stimuli were assessed in 19 anxious (ANX) children before and after cognitive behavioural therapy (CBT), and compared with responses from 19 non-anxious (NA) control children collected over the same period. Attentional bias was assessed using a picture version of the visual probe task with threat, neutral and pleasant pictures. Threat interpretation bias was assessed using both a homographs task in which children used homograph words in a sentence and their neutral or threatening meaning was assessed, and a stories task in which children rated their negative emotion, danger judgments, and influencing ability in ambiguous situations. ANX children showed attention biases towards threat on the visual probe task and threat interpretation biases on the stories task but not the homographs task at pre-treatment in comparison with NA children. Following treatment, ANX children's threat interpretation biases as assessed on the stories task reduced significantly to within levels comparable to NA children. However, ANX children continued to show larger attentional biases towards threat than pleasant pictures on the visual probe task at post-treatment, whereas NA children did not show attentional biases. Moreover, a residual threat interpretation style on the stories task at post-treatment was associated with higher anxiety symptoms in both ANX and NA children.     

Attentional Processing of Threat in Bipolar Disorder: Going Beyond Mood-Congruency

Emotional processing in bipolar disorder (BD) entails a complex attentional pattern not merely restricted to happy or sad biases, but also directed towards threatening information. This study examined threat-related bias on attentional orienting when participants were not instructed about the presentation of emotional stimuli (i.e., implicit instructions). An emotional dot-probe task in which an emotional face (i.e., threat, sad, happy) is simultaneously displayed with a neutral face was applied to BD individuals in their different episodes: mania (n?=?26), depression (n?=?24), and euthymia (n?=?28) as well as to a group of healthy controls (n?=?28). Symptomatic BD patients (i.e., in a manic or depressive episode) showed an attentional orienting bias toward threatening faces but not for happy or sad faces, while euthymic BD patients did not exhibit any attentional bias for emotional stimuli. A bias toward happy faces was found in the control group. Threat-related bias was not related to the severity of affective and anxiety symptoms in BD. When attention is not explicitly directed to emotional information, threat-related bias may characterize attentional orienting during mania and depression, but may be attenuated during euthymia.

     

Self-referential schemas and attentional bias predict severity and naturalistic course of depression symptoms

Attentional bias and self-referential schemas have been observed in numerous cross-sectional studies of depressed adults and are theorised to maintain negative mood. However, few longitudinal studies have examined whether maladaptive cognition predicts the course of depressive symptoms. Fifty-seven adults with elevated depression symptoms were assessed for negative attentional bias using a dot-probe task with eye-tracking and self-referential schemas using a self-referent encoding task. Participants subsequently completed five weekly depression symptom assessments. Participants with more negative self-referential schemas had higher baseline depression symptoms (r?=?.55). However, participants who spent more time attending to negative words showed greater symptom worsening over time (r?=?.42). The findings for negative self-referential schemas replicate past research, while the findings for negative attention bias represent the first evidence showing that attentional biases predict naturalistic symptom course. This work suggests that negative attention biases maintain depression symptoms and represent an important treatment target for neurocognitive therapeutics.     

The Relationship Between Attention,Interpretation, and Memory Bias During Facial Perception in Social Anxiety

Although cognitive theories suggest the interactive nature of information processing biases in contributing to social anxiety, most studies to date have investigated these biases in isolation. This study aimed at (a) testing the association between social anxiety and each of the threat-related cognitive biases: attention, interpretation, and memory bias; and (b) examining the relationship between these cognitive biases in facial perception. We recruited an unselected sample of 188 adult participants and measured their level of social anxiety and cognitive biases using faces displaying angry, disgusted, happy, and ambiguous versions of these expressions. All bias tasks were assessed with the same set of facial stimuli. Regression analyses showed that social anxiety symptoms significantly predicted attention avoidance and poorer sensitivity in recognizing threatening faces. Social anxiety was, however, unrelated to interpretation bias in our sample. Results of path analysis suggested that attention bias influenced memory bias indirectly through interpretation bias for angry but not disgusted faces. Our findings suggest that, regardless of social anxiety level, when individuals selectively oriented to faces displaying anger, the faces were interpreted to be more negative. This, in turn, predicted better memory for the angry faces. The results provided further empirical support for the combined cognitive bias hypothesis.     

抑郁症状中学生自我相关生活事件的回忆、再认和启动效应特点

采用Tversky的实验设计,对非抑郁和抑郁症状中学生的回忆、再认和启动效应进行了探讨。实验发现,抑郁症状中学生对自我相关生活事件信息加工存在负性回忆、负性再认、负性启动和负性加工偏向;抑郁症状中学生对自我相关生活事件信息加工的回忆具有情境一致性;对再认材料的不同加工深度影响抑郁症状中学生自我相关生活事件信息加工的再认;抑郁症状中学生对自我相关生活事件信息加工的负性启动主要是由于对负性条目、中性条目的负性偏向加工引起     

Modification of Hostile Interpretation Bias in Depression: A Randomized Controlled Trial

Interpretation Bias Modification (IBM) is gaining attention in the literature as an intervention that alters cognitive biases and reduces associated symptoms. Forty, primarily college-aged, non-treatment-seeking adults with major depressive disorder (MDD) were randomly assigned to receive either IBM targeting hostile interpretation bias (IBM-H) or a healthy video control (HVC) condition. Compared to those in HVC, participants in IBM-H reported more benign interpretations and fewer hostile interpretations at posttreatment. No difference in depressive interpretation bias was found between groups at posttreatment. IBM-H led to improved anger control at posttreatment and follow-up compared to HVC, though no effects of condition were found on trait anger or depressive symptoms. The IBM-H group perceived their treatment as less credible than the HVC group. For individuals with high expectancy of treatment success, IBM-H led to lower posttreatment depressive symptoms compared to HVC, while findings trended in the opposite direction for those with low expectancy of success. Overall, these preliminary findings point to boundary conditions for the efficacy of IBM protocols for anger and depression and potential improvements to be made to future IBM protocols.     

Cognitive dysfunction in depression: neurocircuitry and new therapeutic strategies

Major depressive disorder (MDD) is a disabling medical condition associated with significant morbidity, mortality and public health costs. However, neurocircuitry abnormalities underlying depression remain incompletely understood and consequently current treatment options are unfortunately limited in efficacy. Recent research has begun to focus specifically on cognitive aspects of depression and potential neurobiological correlates. Two fundamental types of cognitive dysfunction observed in MDD are cognitive biases, which include distorted information processing or attentional allocation toward negative stimuli, and cognitive deficits, which include impairments in attention, short-term memory and executive functioning. In this article, we present a selective review of current research findings in these domains and examine neuroimaging research that is beginning to characterize the neurocircuitry underlying these biases and deficits. We propose that deficient cognitive functioning, attention biases and the sustained negative affect characteristic of MDD can be understood as arising in part from dysfunctional prefrontal-subcortical circuitry and related disturbances in the cognitive control of emotion. Finally, we highlight potential new pharmacological and non-pharmacological therapeutic strategies for MDD based on an evolving mechanistic understanding of the disorder.     

Predictors of Symptom Outcome in Interpretation Bias Modification for Dysphoria

Interpretation Bias Modification (IBM) interventions have been effective in reducing negative interpretation biases theorized to underlie depressive psychopathology. Although these programs have been highlighted as potential short-term interventions for depression, mixed evidence has been found for their effects on depressive symptoms. There is a need to examine attitudes towards training as well as individual difference factors that may impact symptom outcomes for IBM depression interventions. Seventy-two dysphoric young adults were randomly assigned to receive either an IBM targeting negative interpretation bias in personal evaluations or interpersonal situations or a healthy video control (HVC) condition. Compared to those who received HVC, participants in the IBM condition reported lower negative interpretation bias at posttreatment. No differences between conditions were found for symptom outcomes. Greater perceived treatment credibility and expectancy were associated with better treatment outcomes for both the IBM and HVC groups. Within the IBM group, a greater tendency toward assimilation with treatment scenarios was significantly associated with better treatment outcomes for both depressive and anger symptoms. This effect was unique from treatment credibility and expectancy. Pretreatment psychological reactance did not predict treatment response for either condition. Implications and future research directions are discussed.     

A meta-analysis of the effect of cognitive bias modification on anxiety and depression

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed.     

The association of relational and physical victimization with hostile attribution bias,emotional distress,and depressive symptoms: A cross‐cultural study

The purpose of the present study was to examine the association between relational victimization and socio‐cognitive patterns (i.e. hostile attribution biases and emotional distress) or social–psychological adjustment problems (i.e. depressive symptoms) in Japanese and European American children (N = 272; ages 9–10). Results showed that relational victimization, which was conceptually different from physical victimization, was associated with a greater level of emotional distress for an overall sample; however, the links between relational victimization and hostile attribution biases and depressive symptoms were evidenced only for Japanese children. A follow‐up analysis revealed that hostile attribution biases had a direct effect on depressive symptoms for European American children; however, these biases mediated the link between relational victimization and depressive symptoms for Japanese children. These findings are discussed from normative and cross‐cultural perspectives.     

Biases in attention and interpretation in adolescents with varying levels of anxiety and depression

ABSTRACT

This is the first study to investigate multiple cognitive biases in adolescence simultaneously, to examine whether anxiety and depression are associated with biases in attention and interpretation, and whether these biases are able to predict unique variance in self-reported levels of anxiety and depression. A total of 681 adolescents performed a Dot Probe Task (DPT), an Emotional Visual Search Task (EVST), and an Interpretation Recognition Task. Attention and interpretation biases were significantly correlated with anxiety. Mixed results were reported with regard to depression: evidence was found for an interpretation bias, and for an attention bias as measured with the EVST but not with the DPT. Furthermore, interpretation and attention biases predicted unique variance in anxiety and depression scores. These results indicate that attention and interpretation biases are unique processes in anxiety and depression. They also suggest that anxiety and depression are partly based on similar underlying cognitive mechanisms.