Interpretation of ambiguous information in girls at risk for depression

A Systematic Review of Experimental Paradigms for Exploring Biased Interpretation of Ambiguous Information with Emotional and Neutral Associations

Interpretation biases have been extensively explored in a range of populations, including patients with anxiety and depressive disorders where they have been argued to influence the onset and maintenance of such conditions. Other populations in which interpretation biases have been explored include patients with chronic pain, anorexia nervosa, and alcohol dependency among others, although this literature is more limited. In this research, stimuli with threatening/emotional and neutral meanings are presented, with participant responses indicative of ambiguity resolution. A large number of paradigms have been designed and implemented in the exploration of interpretation biases, some varying in minor features only. This article provides a review of experimental paradigms available for exploring interpretation biases, with the aim to stimulate and inform the design of future research exploring cognitive biases across a range of populations. A systematic search of the experimental literature was conducted in Medline, PsychINFO, Web of Science, CINAHL, and Cochrane Library databases. Search terms were information, stimuli, and ambiguous intersected with the terms interpretation and bias*. Forty-five paradigms were found, categorized into those using ambiguous words, ambiguous images, and ambiguous scenarios. The key features, strengths and limitations of the paradigms identified are discussed.

Attentional bias to threat in children at-risk for emotional disorders: role of gender and type of maternal emotional disorder

Previous studies suggested that threat biases underlie familial risk for emotional disorders in children. However, major questions remain concerning the moderating role of the offspring gender and the type of parental emotional disorder on this association. This study addresses these questions in a large sample of boys and girls. Participants were 6-12 years old (at screening) typically developing children participating in the High Risk Cohort Study for Psychiatric Disorders (n = 1280; 606 girls, 674 boys). Children were stratified according to maternal emotional disorder (none; mood disorder; anxiety disorder; comorbid anxiety/mood disorder) and gender. Attention biases were assessed using a dot-probe paradigm with threat, happy and neutral faces. A significant gender-by-parental emotional disorder interaction predicted threat bias, independent of anxiety and depression symptoms in children. Daughters of mothers with an emotional disorder showed increased attention to threat compared with daughters of disorder-free mothers, irrespective of the type of maternal emotion disorder. In contrast, attention bias to threat in boys only occurred in mothers with a non-comorbid mood disorder. No group differences were found for biases for happy-face cues. Gender and type of maternal emotional disorder predict attention bias in disorder-free children. This highlights the need for longitudinal research to clarify whether this pattern of threat-attention bias in children relates to the risk of developing anxiety and mood disorders later in life.

The neural networks of subjectively evaluated emotional conflicts

Previous work on the neural underpinnings of emotional conflict processing has largely focused on designs that instruct participants to ignore a distracter which conflicts with a target. In contrast, this study investigated the noninstructed experience and evaluation of an emotional conflict, where positive or negative cues can be subjectively prioritized. To this end, healthy participants freely watched short film scenes that evoked emotional conflicts while their BOLD responses were measured. Participants' individual ratings of conflict and valence perception during the film scenes were collected immediately afterwards, and the individual ratings were regressed against the BOLD data. Our analyses revealed that (a) amygdala and medial prefrontal cortex were significantly involved in prioritizing positive or negative cues, but not in subjective evaluations of conflict per se, and (b) superior temporal sulcus (STS) and inferior parietal lobule (IPL), which have been implicated in social cognition and emotion control, were involved in both prioritizing positive or negative cues and subjectively evaluating conflict, and may thus constitute "hubs" or "switches" in emotional conflict processing. Psychophysiological interaction (PPI) analyses further revealed stronger functional connectivity between IPL and ventral prefrontal-medial parietal areas in prioritizing negative cues, and stronger connectivity between STS and dorsal-rostral prefrontal-medial parietal areas in prioritizing positive cues. In sum, our results suggest that IPL and STS are important in the subjective evaluation of complex conflicts and influence valence prioritization via prefrontal and parietal control centers. Hum Brain Mapp 37:2234-2246, 2016. © 2016 Wiley Periodicals, Inc.

Expected Emotional Usefulness and Emotional Preference in Individuals with Major Depressive Disorder

OBJECTIVE

Previous studies indicate that emotion regulation problems in major depressive disorder (MDD) may be caused by difficulties in preferring useful emotions according to their goals. We investigated expected emotional usefulness and emotional preference in individuals with MDD (MDDs) and healthy controls (HCs).

METHODS

Participants were given an interpersonal scenario with two different goals (confrontation and collaboration) and rated their willingness to participate in emotion-provoking activities and the expected usefulness of a particular emotion.

RESULTS

MDDs were similar to HCs in expected emotional usefulness but showed different patterns of emotional preference. HCs preferred happiness to negative emotions across goals whereas MDDs did not show such pattern. In addition, HCs displayed goal-appropriate preferences whereas MDDs did not prefer certain emotions for specific goals.

CONCLUSION

Although MDDs seemed to understand how useful an emotion can be, they did not show preference for goal-appropriate emotions. Interventions should address why MDDs have difficulty engaging in goal-appropriate emotions despite having full knowledge of the utility of emotions in achieving goals.

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.

Is cognitive bias modification training truly beneficial for adolescents?

BACKGROUND

Cognitive Bias Modification (CBM) has been shown to change interpretation biases commonly associated with anxiety and depression and may help ameliorate symptoms of these disorders. However, its evidence base for adolescents is scarce. Previous results have been hard to interpret because of methodological issues. In particular, many studies have used negative bias training as the control condition. This would tend to inflate any apparent benefits of CBM compared to a neutral control. Most studies also only examined the effects of a single training session and lacked follow-up assessment or ecologically valid outcome measures.

METHOD

Seventy-four adolescents, aged 16-18 years, were randomised to two sessions of CBM training or neutral control. Interpretation bias and mood were assessed three times: at baseline, immediately post-training and 1 week post-training. A controlled experimental stressor was also used, and responses to everyday stressors were recorded for 1 week after training to assess responses to psychological challenges. Feedback for the training programme was collected.

RESULTS

The CBM group reported a greater reduction in negative affect than control participants. However, other hypothesised advantages of CBM were not demonstrated. Regardless of training group, participants reported increased positive interpretations, decreased negative interpretations, reduced depressive symptoms and no change in trait anxiety. The two groups did not differ in their stress reactivity. After controlling for group differences in training performance, all the mood effects disappeared.

CONCLUSIONS

When tested under stringent experimental conditions the effects of CBM in healthy adolescents appear to be minimal. Future studies should concentrate on participants with elevated cognitive biases and/or mood symptoms who may be more sensitive to CBM.

Amygdala responses to salient social cues vary with oxytocin receptor genotype in youth

Depression, anxiety, and posttraumatic stress disorder are linked to altered limbic morphology, dysregulated neuroendocrine function, and heightened amygdala responses to salient social cues. Oxytocin appears to be a potent modulator of amygdala reactivity and neuroendocrine responses to psychosocial stress. Given these stress regulatory effects, there is increasing interest in understanding the role of oxytocin in vulnerability to stress-related clinical disorders. The present study examines the impact of a common functional variant within the oxytocin receptor (OXTR) gene (rs2254298) on structure and function of the amygdala in a high-risk sample of urban, low-income, minority youth with a high incidence of early life stress (ELS). Compared to G/G homozygotes, youth carrying the OXTR A-allele showed increased amygdala volume, reduced behavioral performance, and heightened amygdala response during two functional magnetic resonance imaging (fMRI) tasks that involved viewing socially-relevant face stimuli. Higher amygdala response was related to ELS in A-allele carriers but not G/G homozygotes. These findings underscore a series of relations among a common oxytocin system gene variant, ELS exposure, and structure and function of the amygdala in early life. Heightened amygdala response to salient social cues in OXTR A-allele carriers may elevate risk for emotional psychopathology by increasing amygdala involvement in disambiguating environmental cues, particularly for individuals with ELS.

Autobiographical Memory Disturbances in Depression: A Novel Therapeutic Target?

Major depressive disorder (MDD) is characterized by a dysfunctional processing of autobiographical memories. We review the following core domains of deficit: systematic biases favoring materials of negative emotional valence; diminished access and response to positive memories; a recollection of overgeneral memories in detriment of specific autobiographical memories; and the role of ruminative processes and avoidance when dealing with autobiographical memories. Furthermore, we review evidence from functional neuroimaging studies of neural circuits activated by the recollection of autobiographical memories in both healthy and depressive individuals. Disruptions in autobiographical memories predispose and portend onset and maintenance of depression. Thus, we discuss emerging therapeutics that target memory difficulties in those with depression. We review strategies for this clinical domain, including memory specificity training, method-of-loci, memory rescripting, and real-time fMRI neurofeedback training of amygdala activity in depression. We propose that the manipulation of the reconsolidation of autobiographical memories in depression might represent a novel yet largely unexplored, domain-specific, therapeutic opportunity for depression treatment.

Current maternal depression moderates the relation between critical expressed emotion in mothers and depressive symptoms in their adolescent daughters

Prior studies have examined critical expressed emotion (EE-Crit) in mothers in the intergenerational transmission of depression. However, the potential moderating effect of maternal depression diagnostic status in relation to EE-Crit and youth depressive symptoms has yet to be determined. A total of N=121 biological mother/daughter dyads that differed in maternal depression diagnostic status were recruited for the present study: (1) currently depressed mothers (current depression, n=29); (2) formerly depressed mothers (past depression, n=39); and (3) mothers free from any psychiatric history (healthy controls, n=53). Mothers were administered structured clinical interviews and completed self-report measures of EE-Crit and psychopathology, and daughters self-reported depressive symptoms. Results indicated no significant group differences in EE-Crit; however, current maternal depression status moderated EE-Crit such that the magnitude of the relation between EE-Crit and adolescent depressive symptoms was significantly greater in daughters of currently depressed mothers. These findings highlight the importance of considering current maternal depression, rather than a history of maternal depression, in relation to EE-Crit and adolescent depressive symptoms, providing impetus for future investigations.

Cognitive bias, hand preference and welfare of common marmosets

Common marmosets (Callithrix jacchus) have hand preferences for grasping pieces of food and holding them while eating and these are stable throughout adult life. We report here that left-handed marmosets have negative cognitive bias compared to right-handed marmosets. Twelve marmosets were trained to expect a food reward from a bowl with a black lid and not from one with a white lid, or vice versa. In probe tests with ambiguous, grey-lidded bowls a left-handed group (N=7) were less likely to remove the lid to inspect the bowl than a right-handed group (N=5). This difference between left- and right-handed marmosets was not dependent on rate of learning, sex or age. In fact, hand-preference was not associated with rate of learning the task. Furthermore, retrospective examination of colony records of 39 marmosets revealed that more aggression was directed towards left- than right-handed marmosets. Hence, hand preference, which can be measured easily, could serve as an indicator of cognitive bias and may signal a need for particular care in laboratory environments. We explain the results by arguing that hand preference reflects more frequent (or dominant) use of the opposite hemisphere and this predisposes individuals to behave differently.

The neuroscience of depression: implications for assessment and intervention

Major Depressive Disorder (MDD) is among the most prevalent of all psychiatric disorders and is the single most burdensome disease worldwide. In attempting to understand the profound deficits that characterize MDD across multiple domains of functioning, researchers have identified aberrations in brain structure and function in individuals diagnosed with this disorder. In this review we synthesize recent data from human neuroimaging studies in presenting an integrated neural network framework for understanding the impairments experienced by individuals with MDD. We discuss the implications of these findings for assessment of and intervention for MDD. We conclude by offering directions for future research that we believe will advance our understanding of neural factors that contribute to the etiology and course of depression, and to recovery from this debilitating disorder.

What is the contribution of different cognitive biases and stressful childhood events to the presence and number of previous depressive episodes?

Negative cognitive biases as well as stressful childhood events are well-known risk factors for depression. Few studies have compared the association of different types of biases and events with depression. The current study examined whether different cognitive biases and stressful childhood events variables were associated with depression and recurrence. Three types of childhood events were assessed in 83 never-depressed and 337 formerly depressed individuals: trauma within the family, trauma outside the family, and adverse events. Furthermore, after a sad mood induction procedure, participants executed a Dot Probe task (selective attentional bias), an Emotional Stroop task (attentional interference bias) and an incidental learning task (memory bias). The association of these measures with case status and recurrence status (one or multiple past episodes) was examined. Negative memory bias and traumatic childhood events within the family were associated with case status, whereas none of the bias measures or childhood events variables were associated with recurrence status. The results indicate that memory bias as well as the experience of aggression and/or abuse within the family during childhood are independently associated with depression. Biases and stressful childhood events did not offer differentiation between individuals with one or multiple past episodes.

Disruptions in autobiographical memory processing in depression and the emergence of memory therapeutics

Depression is characterized by distinct profiles of disturbance in ways autobiographical memories are represented, recalled, and maintained. We review four core domains of difficulty: systematic biases in favor of negative material; impoverished access and responses to positive memories; reduced access to the specific details of the personal past; and dysfunctional processes of rumination and avoidance around personal autobiographical material. These difficulties drive the onset and maintenance of depression; consequently, interventions targeted at these maladaptive processes have clinical potential. Memory therapeutics is the development of novel clinical techniques, translated from basic research, that target memory difficulties in those with emotional disorders. We discuss prototypical examples from this clinical domain including MEmory Specificity Training, positive memory elaboration, memory rescripting, and the method-of-loci (MoL).

Cognitive bias modification to prevent depression (COPE): study protocol for a randomised controlled trial

Background

Depression is a leading cause of disability worldwide and, although efficacious treatments are available, their efficacy is suboptimal and recurrence of symptoms is common. Effective preventive strategies could reduce disability and the long term social and health complications associated with the disorder, but current options are limited. Cognitive bias modification (CBM) is a novel, simple, and safe intervention that addresses attentional and interpretive biases associated with anxiety, dysphoria, and depression. The primary aim of this trial is to determine if CBM decreases the one-year onset of a major depressive episode among adults with subsyndromal depression.

Design and methods

This randomised controlled trial will recruit 532 adults with subsyndromal symptoms of depression living in the Australian community (parallel design, 1:1 allocation ratio). Participants will be free of clinically significant symptoms of depression and of psychotic disorders, sensory and cognitive impairment, and risky alcohol use. The CBM intervention will target attentional and interpretive biases associated with depressive symptoms. The sessions will be delivered via the internet over a period of 52 weeks. The primary outcome of interest is the onset of a major depressive episode according the DSM-IV-TR criteria over a 12-month period. Secondary outcomes of interest include change in the severity of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9), use of antidepressants or benzodiazepines, and changes in attention and interpretive biases. The assessment of outcomes will take place 3, 6, 9, and 12 months after randomisation and will occur via the internet.

Discussion

We propose to test the efficacy of an innovative intervention that is well grounded in theory and for which increasing empirical evidence for an effect on mood is available. The intervention is simple, inexpensive, easy to access, and could be easily rolled out into practice if our findings confirm a role for CBM in the prevention of depression.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12613001334796. Date: 5th December 2013.

Modelling cognitive affective biases in major depressive disorder using rodents

Major depressive disorder (MDD) affects more than 10% of the population, although our understanding of the underlying aetiology of the disease and how antidepressant drugs act to remediate symptoms is limited. Major obstacles include the lack of availability of good animal models that replicate aspects of the phenotype and tests to assay depression-like behaviour in non-human species. To date, research in rodents has been dominated by two types of assays designed to test for depression-like behaviour: behavioural despair tests, such as the forced swim test, and measures of anhedonia, such as the sucrose preference test. These tests have shown relatively good predictive validity in terms of antidepressant efficacy, but have limited translational validity. Recent developments in clinical research have revealed that cognitive affective biases (CABs) are a key feature of MDD. Through the development of neuropsychological tests to provide objective measures of CAB in humans, we have the opportunity to use ‘reverse translation’ to develop and evaluate whether similar methods are suitable for research into MDD using animals. The first example of this approach was reported in 2004 where rodents in a putative negative affective state were shown to exhibit pessimistic choices in a judgement bias task. Subsequent work in both judgement bias tests and a novel affective bias task suggest that these types of assay may provide translational methods for studying MDD using animals. This review considers recent work in this area and the pharmacological and translational validity of these new animal models of CABs.

Positive interpretation bias predicts well-being in medical interns

Cognitive theories of emotion posit that affective responses may be shaped by how individuals interpret emotion-eliciting situations. This study tested whether individual differences in interpretation bias (i.e., interpreting ambiguous scenarios in a more negative or positive manner) independently predict trait resilience and depression in medical interns. Interpretation bias and trait resilience scores were assessed in 47 interns prior to their first internship. Depressive symptoms were assessed twice during internship. Nearly half of the sample (42%) scored above the cut-off for mild depressive symptoms during internship, a significant rise compared to the initial assessment. Those with a more positive interpretation bias had higher trait resilience (β = 0.44, p = 0.004) and a 6-fold decreased depressive symptom risk during internship (OR = 6.41, p = 0.027). The predictive power of a positive interpretation bias for decreased depression symptoms held over and above initial depressive symptoms, demographics and trait reappraisal. Assessing positive interpretation bias may have practical utility for predicting future well-being in at risk-populations.

Cognitive processes and emotion regulation in depression

Sustained negative affect and diminished positive affect are hallmark features of Major Depressive Disorder (MDD). Difficulties in emotion regulation have been proposed to be at the core of these cardinal symptoms of MDD. It remains unclear, however, what underlies emotion regulation difficulties. Cognitive theories of depression have focused on cognitive processes and recent studies suggest that cognitive biases and deficits in cognitive control may help explain affective symptoms of this disorder. Specifically, it is proposed that cognitive biases and deficits affect emotion regulation ability thereby setting the stage for maintained negative affect and diminished levels of positive affect. The article reviews empirical studies that speak to these links and closes with a discussion of novel treatment approaches that are inspired by these ideas.

Interpretation bias characterizes trait rumination

BACKGROUND AND OBJECTIVES

Rumination, a maladaptive cognitive style of responding to negative mood, is thought to be maintained by a variety of cognitive biases. However, it is unknown whether rumination is characterized by interpretation biases.

METHODS

Two experiments examined the link between rumination and interpretation biases, revealed in lexical-decision tasks (LDT). A homograph with both benign and ruminative or otherwise negative meaning was presented on each trial and followed by a letter string, to which participants responded by judging whether it was a word or a non-word. Letter strings were non-words or words related or unrelated to one meaning of the homograph.

RESULTS

In both experiments, faster latencies to respond to targets related to the ruminative meaning of the homographs were produced by students with higher scores on self-report measures of rumination. Moreover, these biases were associated with both brooding, the maladaptive form of rumination, and reflection, the more adaptive component. No measure of rumination was significantly correlated with general biases toward negative meaning (Experiment 1) or with threatening interpretations of homographs (Experiment 2).

LIMITATIONS

The paucity of available rumination-related homographs dictated the use of non-fully randomized stimuli presentation (Experiment 1) or the use of only one set of the meanings associated with the homographs (Experiment 2).

CONCLUSIONS

Rumination is associated with a tendency to interpret ambiguous information in a rumination-consistent manner. This tendency may exacerbate ruminative thinking and can possibly be a target for future intervention.

Understanding Familial Risk for Depression

Major depressive disorder (MDD) is among the most prevalent, debilitating, and costly of all illnesses worldwide. Investigators have made considerable progress in elucidating psychological and biological correlates of MDD; however, far less is known about factors that are implicated in risk for depression. Given the high risk for MDD associated with a family history of depression, investigators have worked to understand both the effects of parental depression on offspring and the mechanisms that might underlie familial risk for MDD. In this article, we describe the evolution of investigators’ understanding of the psychobiological functioning of children of depressed parents, and we present recent findings concerning cognitive and neural aspects of risk for MDD using our high-risk sample as a context and foundation for this discussion. We integrate these data in a conceptualization of mechanisms underlying risk for depression, focusing on the constructs of emotion dysregulation and stress reactivity. Recognizing the 25-year anniversary of the Association for Psychological Science, we place this presentation in the context of the past 25 years of research on depression. We conclude by discussing the significance of emotion dysregulation and stress reactivity for studying risk for depression, for developing approaches to prevent MDD, and for moving theory and research in this field forward.

Using multiple methods to characterize the phenotype of individuals with a family history of major depressive disorder

BACKGROUND

Unaffected relatives (URs) of individuals with major depressive disorder (MDD) are biologically more vulnerable to depression. We compare healthy URs and controls at the level of phenotype (symptoms and functioning) and endophenotype (negative emotion bias), and further investigate the interrelation between these and the contribution of environmental early life stress.

METHODS

URs (n=101), identified using Family History Screen interview methods and matched controls completed written and interview questions assessing symptoms of depression and anxiety, negative cognitive style, life functioning and early life stress. Biases in emotion processing were measured using a facial expression of emotion identification paradigm.

RESULTS

Compared to controls, URs reported higher levels of depression and anxiety, a stronger negative cognitive bias, and poorer functioning and lower satisfaction with life. URs were slower to correctly identify fear and sad facial expressions. A slower response time to identify sad faces was correlated with lower quality of life in the social domain. Early life stress (ELS) did not contribute significantly to any outcome.

LIMITATIONS

The methodology relies on accurate reporting of participants' own psychiatric history and that of their family members. The degree of vulnerability varies among URs.

CONCLUSIONS

A family history of depression accounts for subtle differences in symptom levels and functioning without a necessary role of ELS. A negative emotion bias in processing emotion may be one vulnerability marker for MDD. Biological markers may affect functioning measures before symptoms at the level of experience.

Depressão materna e riscos para o comportamento e a saúde mental das crianças: uma revisão

A depressão materna tem sido considerada um fator de risco para a saúde mental das crianças. Objetivou-se identificar e analisar na literatura indexada artigos empíricos recentes (2005 a 2012), que abordaram as associações da depressão materna ao comportamento e à saúde mental de crianças, escolares. Procedeu-se a uma busca sistemática nas bases PubMed, PsycInfo e LILACS, por meio das palavras-chave "Maternal Depression or Depression" e "Risk Factors". Foram selecionados e analisados 68 artigos, 23 transversais e 45 longitudinais. Independentemente dos delineamentos adotados, a depressão materna mostrou-se associada à presença de dificuldades emocionais e comportamentais em geral, de manifestações depressivas e de ansiedade. Além da depressão materna, outras variáveis contextuais mostraram-se associadas às dificuldades das crianças. O reconhecimento da ação de múltiplas variáveis permitiu a verificação de indicadores diversos, o que pode favorecer o planejamento de intervenções.

The role of peer rejection in adolescent depression

Adolescence is a period of major risk for depression, which is associated with negative personal, social, and educational outcomes. Yet, in comparison to adult models of depression, very little is known about the specific psychosocial stressors that contribute to adolescent depression, and whether these can be targeted by interventions. In this review, we consider the role of peer rejection. First, we present a comprehensive review of studies using innovative experimental paradigms to understand the role of peer rejection in adolescent depression. We show how reciprocal relationships between peer rejection and depressive symptoms across adolescence powerfully shape and maintain maladaptive trajectories. Second, we consider how cognitive biases and their neurobiological substrates may explain why some adolescents are more vulnerable to the effects of, and perhaps exposure to, peer rejection compared to others. Finally, we draw attention to emerging cognitive and functional magnetic resonance imaging-based neurofeedback training, which by modifying aspects of information processing may promote more adaptive responses to peer rejection. A better understanding of the mechanisms underlying adolescent depression may not only alleviate symptoms during a period of substantial developmental challenges, but may also reduce the burden of the disorder across the lifespan.

Efficacy of Interpretation Bias Modification in Depressed Adolescents and Young Adults

This study evaluated the efficacy of a four-session Cognitive Bias Modification-Interpretation program for 45 depressed adolescents and young adults (14-21 years old; 12 males, 33 females; Beck Depressive Inventory, Second Edition ≥ 14) randomized to an active intervention condition (repeated exposure to positive outcomes of depression-relevant ambiguous scenarios; n=23) or a control condition (n=22). Both conditions experienced reductions on a Test of Interpretation Bias at post-treatment, with no significant between-group differences. When limited to those with negative bias at baseline, the intervention group showed greater improvement in interpretation bias at mid- and post-treatment. In addition, the intervention group overall had greater improvements in self-reported negative cognitions than the control group at post-intervention and two-week follow-up. However, there were no differences between groups in depression or anxiety symptom change. Potential factors contributing to mixed findings are discussed.

Peer victimization in childhood and internalizing problems in adolescence: a prospective longitudinal study

Traumatic childhood experiences have been found to predict later internalizing problems. This prospective longitudinal study investigated whether repeated and intentional harm doing by peers (peer victimization) in childhood predicts internalizing symptoms in early adolescence. 3,692 children from the Avon Longitudinal Study of Parents and Children (ALSPAC), as well as their mothers and teachers, reported on bullying in childhood (7-10 years) and internalizing problems in early adolescence (11-14 years). Controlling for prior psychopathology, family adversity, gender and IQ, being a victim of bullying was associated with higher overall scores, as well as increased odds of scoring in the severe range (>90(th) percentile) for emotional and depression symptoms. Victims were also more likely to show persistent depression symptoms over a 2-year period. These associations were found independent of whether mothers, teachers or the children reported on bullying. It is concluded that peer victimization in childhood is a precursor of both short-lived and persistent internalizing symptoms, underlining the importance of environmental factors such as peer relationships in the etiology of internalizing problems.

Facial emotion expression recognition by children at familial risk for depression: high-risk boys are oversensitive to sadness

BACKGROUND

Offspring of depressed parents are at greatly increased risk for mood disorders. Among potential mechanisms of risk, recent studies have focused on information processing anomalies, such as attention and memory biases, in the offspring of depressed parents. In this study we examined another information processing domain, perceptual sensitivity to emotion cues in facial expressions, as a potential mechanism of risk that characterizes the offspring of depressed parents.

METHODS

The study included 64 children at familial-risk for depression and 40 low-risk peers between the ages 7 and 13(Mage = 9.51; SD = 2.27). Participants were presented with pictures of facial expressions that varied in emotional intensity from neutral to full-intensity sadness or anger (i.e., emotion recognition), or pictures of faces morphing from anger to sadness (emotion discrimination). After each picture was presented, children indicated whether the face showed a specific emotion (i.e., sadness, anger) or no emotion at all (neutral) using a forced choice paradigm. We examined group differences in the intensity of emotion that suggested greater sensitivity to specific emotions.

RESULTS

In the emotion recognition task, boys (but not girls) at familial-risk for depression identified sadness at significantly lower levels of emotional intensity than did their low-risk peers. The high and low-risk groups did not differ with regard to identification of anger. In the emotion discrimination task, both groups displayed over-identification of sadness in ambiguous mixed faces but high-risk youth were less likely to show this labeling bias than their peers.

CONCLUSION

Our findings are consistent with the hypothesis that enhanced perceptual sensitivity to subtle traces of sadness in facial expressions may be a potential mechanism of risk among boys at familial-risk for depression. This enhanced perceptual sensitivity does not appear to be due to biases in the labeling of ambiguous faces.

Biased processing of sleep-related stimuli in children of parents with insomnia

Disorder-specific cognitive biases have been observed in children whose parents suffer from psychological disorders. Despite those same biases being observed in individuals with insomnia, they have yet to be explored as an index of vulnerability in children of parents with insomnia. It was hypothesized that potentially vulnerable children would demonstrate cognitive biases to sleep-related cues, relative to controls. Following a "tired-state induction," a sleep-related Emotional Stroop was completed by 2 groups: 38 children of parents with insomnia and 51 controls. Children also reported their observations about the content of the Stroop words. Results showed an attention bias in children whose parents have insomnia, but no interpretive bias. The results are discussed in terms of a predispositional vulnerability to insomnia.

Cognitive and neural aspects of information processing in major depressive disorder: an integrative perspective

Researchers using experimental paradigms to examine cognitive processes have demonstrated that Major Depressive Disorder (MDD) is associated not with a general deficit in cognitive functioning, but instead with more specific anomalies in the processing of negatively valenced material. Indeed, cognitive theories of depression posit that negative biases in the processing of information play a critical role in influencing the onset, maintenance, and recurrence of depressive episodes. In this paper we review findings from behavioral studies documenting that MDD is associated with specific difficulties in attentional disengagement from negatively valenced material, with tendencies to interpret information in a negative manner, with deficits in cognitive control in the processing of negative material, and with enhanced memory for negative material. To gain a better understanding of the neurobiological basis of these abnormalities, we also examine findings from functional neuroimaging studies of depression and show that dysfunction in neural systems that subserve emotion processing, inhibition, and attention may underlie and contribute to the deficits in cognition that have been documented in depressed individuals. Finally, we briefly review evidence from studies of children who are at high familial risk for depression that indicates that abnormalities in cognition and neural function are observable before the onset of MDD and, consequently, may represent a risk factor for the development of this disorder. By integrating research from cognitive and neural investigations of depression, we can gain a more comprehensive understanding not only of how cognitive and biological factors interact to affect the onset, maintenance, and course of MDD, but also of how such research can aid in the development of targeted strategies for the prevention and treatment of this debilitating disorder.

Affective and physiological responses to stress in girls at elevated risk for depression

Children of depressed parents are significantly more likely to develop depression and other mental health disorders than are children of never-depressed parents. Investigations of the physiological mechanisms underlying this elevated risk have generally focused on basal functioning. It is important to note, however, that physiological reactivity or responses to stress are also critical determinants of mental and physical health. In the current study, we examined whether children of depressed parents exhibit altered physiological responses to stress. In two studies, never-depressed adolescent daughters of either recurrently depressed mothers (RISK) or never-depressed mothers (CTL) underwent social stressors while their physiological responses were measured (cortisol in Study 1, heart rate in Study 2). In both studies, affective responses to the stressors predicted physiological responses in RISK girls, but not in never-depressed girls. For RISK girls, decreased positive affect in response to stress predicted increased cortisol reactivity; in addition, decreased positive affect and increased negative affect were associated with poorer heart rate recovery and habituation, respectively. Future research is needed to examine explicitly whether this coherence between affect and physiology is a mechanism underlying the increased risk for psychopathology in children of depressed parents.

Emotion in psychogenic nonepileptic seizures: responses to affective pictures

We examined emotional responses to standard affective pictures in 18 psychogenic nonepileptic seizure (PNES) patients. Given reports of trauma and posttraumatic stress symptoms (PTS) in many PNES patients, comparison groups were seizure-free individuals high and low in PTS (PTS-high, PTS-low; n=18 per group). Patients with psychogenic nonepileptic seizures (1) reported more emotional intensity to neutral and pleasant pictures than PTS-low and more intensity to neutral pictures than PTS-high, and (2) showed less positive emotional behavior to pleasant pictures than PTS-high. Groups did not differ in pleasantness/unpleasantness ratings, negative emotional behavior, cardiac interbeat interval, or respiratory sinus arrhythmia (RSA) reactivity to the pictures. Patients with psychogenic nonepileptic seizures reported more general emotion regulation difficulties and showed lower baseline RSA than PTS-low but not PTS-high. In sum, intense emotional experience and diminished positive emotional behavior characterized PNES patients' emotional responses.

Cognitive Aspects of Depression

Depression is a prevalent and impairing psychiatric disorder that affects how we feel and how we think about ourselves and the world around us. Cognitive theories of depression have long posited that various thought processes are involved in the development, maintenance, and recurrence of depressive episodes. Contemporary research has utilized experimental procedures to examine cognitive processes in depressed individuals as well as the nature of the relation of these processes to the emotion dysregulation that is central to the disorder. For example, investigators have assessed the ways in which depression alters aspects of information processing, including attention and perception, interpretation, and memory processes; this research has generated relatively consistent findings. In addition, researchers have attempted to identify and elucidate the cognitive mechanisms that may link these biases in information processing to emotion dysregulation in depression. These mechanisms include inhibitory processes and deficits in working memory, ruminative responses to negative mood states, and the inability to use positive and rewarding stimuli to regulate negative mood. Results of these investigations converge on the formulation that depression is associated with increased elaboration of negative information, difficulties in cognitive control when processing this information, and difficulties disengaging from this information. Research examining cognitive aspects of depression not only enhances our understanding of this common and costly disorder, but also has implications for the treatment of depression and for future investigations of the biological foundations of this disorder.

Coping, Negative Cognitive Style and Depressive Symptoms in Children of Depressed Parents

Coping and negative cognitive style were studied in relation to depressive symptoms in children at risk for depression. In a sample of 165 children (ages 9-15) of depressed parents, the main and interaction effects of coping and negative cognitive style were examined in association with children's depressive symptoms measured by parent and child report on questionnaires and diagnostic interviews. Negative cognitive style was related to three types of coping (primary control, secondary control, and disengagement). Furthermore, coping and negative cognitive style made independent contributions to depressive symptoms. Little support emerged for interactive effects on depressive symptoms. Implications for future research with this high-risk population of children are considered.

Neurobiological markers of familial risk for depression

Major depression is associated with a wide range of neurobiological disturbances, including anomalies in the structure and function of cortical and subcortical gray matter and dysregulation of the HPA axis. In this chapter, we review research demonstrating that many of these abnormalities are also present in never-depressed offspring of adults with recurrent depression and discuss how such findings might reflect dysfunctional neuroregulatory systems that precede the onset of this disorder. We also briefly discuss candidate genes and environmental factors that have been posited to be directly involved in the transmission of neural and HPA-axis abnormalities from depressed parents to their offspring, and we review how, by obtaining a better understanding of the neurobiological markers of depression risk, we can facilitate the development of targeted strategies for the prevention and treatment of major depression.

Interpretation of ambiguous social scenarios in social phobia and depression: evidence from event-related brain potentials

In the current study, event-related potentials (ERPs) and behavioral responses were measured in individuals meeting diagnostic criteria for social phobia, depression, their combination, or neither in order to examine the unique and combined effects of social phobia and depression on the interpretation of ambiguous social scenarios. ERPs revealed a lack of positive interpretation bias and some suggestion of a negative bias in the semantic expectancy N4 component across all clinical groups. Furthermore, socially phobic and comorbid individuals showed reductions in baseline attention allocation to the task, as indexed by P6 amplitude. RT and accuracy likewise revealed a lack of positive interpretation bias across disordered groups. When considered on a continuum across all samples, social phobia and depression symptoms were related to the N4 interpretation bias effect whereas P6 amplitude reduction and RT interpretation bias appeared uniquely associated with social phobia.

Access of emotional information to visual awareness in patients with major depressive disorder

BACKGROUND

According to cognitive theories of depression, negative biases affect most cognitive processes including perception. Such depressive perception may result not only from biased cognitive appraisal but also from automatic processing biases that influence the access of sensory information to awareness.

METHOD

Twenty patients with major depressive disorder (MDD) and 20 healthy control participants underwent behavioural testing with a variant of binocular rivalry, continuous flash suppression (CFS), to investigate the potency of emotional visual stimuli to gain access to awareness. While a neutral, fearful, happy or sad emotional face was presented to one eye, high-contrast dynamic patterns were presented to the other eye, resulting in initial suppression of the face from awareness. Participants indicated the location of the face with a key press as soon as it became visible. The modulation of suppression time by emotional expression was taken as an index of unconscious emotion processing.

RESULTS

We found a significant difference in the emotional modulation of suppression time between MDD patients and controls. This difference was due to relatively shorter suppression of sad faces and, to a lesser degree, to longer suppression of happy faces in MDD. Suppression time modulation by sad expression correlated with change in self-reported severity of depression after 4 weeks.

CONCLUSIONS

Our finding of preferential access to awareness for mood-congruent stimuli supports the notion that depressive perception may be related to altered sensory information processing even at automatic processing stages. Such perceptual biases towards mood-congruent information may reinforce depressed mood and contribute to negative cognitive biases.

Attentional biases for emotional faces in young children of mothers with chronic or recurrent depression

Attentional biases for negative stimuli have been observed in school-age and adolescent children of depressed mothers and may reflect a vulnerability to depression. The direction of these biases and whether they can be identified in early childhood remains unclear. The current study examined attentional biases in 5-7-year-old children of depressed and non-depressed mothers. Following a mood induction, children participated in a dot-probe task assessing biases for sad and happy faces. There was a significant interaction of group and sex: daughters of depressed mothers attended selectively to sad faces, while children of controls and sons of depressed mothers did not exhibit biases. No effects were found for happy stimuli. These findings suggest that attentional biases are discernible in early childhood and may be vulnerability markers for depression. The results also raise the possibility that sex differences in cognitive biases are evident before the emergence of sex differences in the prevalence of depression.

Defining reactivity: how several methodological decisions can affect conclusions about emotional reactivity in psychopathology

There are many important methodological decisions that need to be made when examining emotional reactivity in psychopathology. In the present study, we examined the effects of two such decisions in an investigation of emotional reactivity in depression: (1) which (if any) comparison condition to employ; and (2) how to define change. Depressed (N = 69) and control (N = 37) participants viewed emotion-inducing film clips while subjective and facial responses were measured. Emotional reactivity was defined using no comparison condition (i.e., raw scores), baseline comparison condition (i.e., no stimulus presented), and neutral comparison condition (i.e., neutral stimulus presented). Change in emotional reactivity was assessed using four analytic approaches: difference scores, percentage change, residualised change, and ANCOVA. Results differed among the three comparison conditions and among several of the analytic approaches. Overall, our investigation suggests that choosing a comparison condition and the definition of change can significantly influence the presence of group differences in emotional reactivity. Recommendations for studies of emotional reactivity in psychopathology are discussed.

The GABAergic deficit hypothesis of major depressive disorder

Increasing evidence points to an association between major depressive disorders (MDDs) and diverse types of GABAergic deficits. In this review, we summarize clinical and preclinical evidence supporting a central and causal role of GABAergic deficits in the etiology of depressive disorders. Studies of depressed patients indicate that MDDs are accompanied by reduced brain concentration of the inhibitory neurotransmitter γ-aminobutyric acid (GABA) and by alterations in the subunit composition of the principal receptors (GABA(A) receptors) mediating GABAergic inhibition. In addition, there is abundant evidence that suggests that GABA has a prominent role in the brain control of stress, the most important vulnerability factor in mood disorders. Furthermore, preclinical evidence suggests that currently used antidepressant drugs (ADs) designed to alter monoaminergic transmission and nonpharmacological therapies may ultimately act to counteract GABAergic deficits. In particular, GABAergic transmission has an important role in the control of hippocampal neurogenesis and neural maturation, which are now established as cellular substrates of most if not all antidepressant therapies. Finally, comparatively modest deficits in GABAergic transmission in GABA(A) receptor-deficient mice are sufficient to cause behavioral, cognitive, neuroanatomical and neuroendocrine phenotypes, as well as AD response characteristics expected of an animal model of MDD. The GABAergic hypothesis of MDD suggests that alterations in GABAergic transmission represent fundamentally important aspects of the etiological sequelae of MDDs that are reversed by monoaminergic AD action.

Neuropsychologische Aspekte der Depression

Zusammenfassung. Patienten mit Depressionen klagen häufig über Symptome und Störungen nicht nur auf der emotionalen, sondern auch auf der kognitiven Ebene. In dieser Übersichtsarbeit werden schwerpunktmäßig neuropsychologische Befunde zu kognitiven Funktionen bei unipolaren Depressionen zusammengefasst. Die kognitive Theorie der Depression postulierte eine Beeinflussung kognitiver Vorgänge durch emotionale Verzerrungen, die eine wichtige Rolle bei Vulnerabilität, Entstehung, Aufrechterhaltung und Rezidiven depressiver Episoden spielen. Befunde zu dieser Interaktion von kognitiven und emotionalen Prozessen werden dargestellt, außerdem wird auf die Bedeutung dieser Aspekte für die Emotionsregulation und für die Therapie der Depression eingegangen.

Emotion Regulation and the Cognitive-Experimental Approach to Emotional Dysfunction

Since the 1980s, there has been a steady growth of interest in the psychological mechanisms that regulate normal emotional experience. In this same period, cognitive-experimental researchers have sought to delineate the information processing biases that characterize emotional disorders. Exciting potential synergies exist between these two areas of investigation. In this article, we consider ways in which reciprocal benefits could be gained by the constructive transfer of theoretical ideas and methodological approaches between emotion regulation researchers and cognitive-experimental investigators. We also discuss how recent innovations within each field can profitably impact upon progress within the other. It is concluded that the overlap in conceptual constructs, and the convergence of complementary investigative techniques, between these two research domains, provide opportunities for creative synthesis that could significantly enrich understanding of normal and abnormal emotion across future years.