Understanding vulnerability for depression from a cognitive neuroscience perspective: A reappraisal of attentional factors and a new conceptual framework

Prenatal Maternal Stress, Child Cortical Thickness, and Adolescent Depressive Symptoms

Prenatal maternal stress predicts subsequent elevations in youth depressive symptoms, but the neural processes associated with these links are unclear. This study evaluated whether prenatal maternal stress is associated with child brain development, and adolescent depressive symptoms using a prospective design with 74 mother child pairs (40 boys). Maternal stress was assessed during pregnancy, child cortical thickness at age 7, and depressive symptoms at age 12. Prenatal maternal stress was associated with less cortical thickness primarily in frontal and temporal regions and with elevated depressive symptoms; child cortical thickness additionally correlated with adolescent depressive symptoms. The observed associations are consistent with the possibility that cortical thickness in superior frontal regions links associations between prenatal maternal stress and adolescent depressive symptoms.

A relationship between weak attentional control and cognitive distortions, explained by negative affect

People high in negative affect (anxiety or depression) show cognitive distortions, specific thinking errors which contribute to the maintenance of their condition. It is thought that weak attentional control is a risk factor for negative affect and emotional disorders, because weak attentional control exaggerates the expression of attentional bias, another cognitive feature of emotional disorders. We wondered whether weak attentional control might similarly exaggerate the expression of cognitive distortions. In two samples of students from Turkey and the UK, we found that weak attentional control was indeed related to cognitive distortions, but this relationship was explained by both variables’ relationships with negative affect. This suggests that weak attentional control, while related to negative affect, does not necessarily exaggerate all of its cognitive features. There seems to be a limit on the affective consequences of poor attentional control, which may limit its clinical usefulness as a risk factor for emotional disorders.

Genome-wide association analysis reveals KCTD12 and miR-383-binding genes in the background of rumination

Ruminative response style is a passive and repetitive way of responding to stress, associated with several disorders. Although twin and candidate gene studies have proven the genetic underpinnings of rumination, no genome-wide association study (GWAS) has been conducted yet. We performed a GWAS on ruminative response style and its two subtypes, brooding and reflection, among 1758 European adults recruited in the general population of Budapest, Hungary, and Manchester, United Kingdom. We evaluated single-nucleotide polymorphism (SNP)-based, gene-based and gene set-based tests, together with inferences on genes regulated by our most significant SNPs. While no genome-wide significant hit emerged at the SNP level, the association of rumination survived correction for multiple testing with KCTD12 at the gene level, and with the set of genes binding miR-383 at the gene set level. SNP-level results were concordant between the Budapest and Manchester subsamples for all three rumination phenotypes. SNP-level results and their links to brain expression levels based on external databases supported the role of KCTD12, SRGAP3, and SETD5 in rumination, CDH12 in brooding, and DPYSL5, MAPRE3, KCNK3, ATXN7L3B, and TPH2 in reflection, among others. The relatively low sample size is a limitation of our study. Results of the first GWAS on rumination identified genes previously implicated in psychiatric disorders underscoring the transdiagnostic nature of rumination, and pointed to the possible role of the dorsolateral prefrontal cortex, hippocampus, and cerebellum in this cognitive process.

Leveraging Neuroplasticity to Enhance Adaptive Learning: The Potential for Synergistic Somatic-Behavioral Treatment Combinations to Improve Clinical Outcomes in Depression

Until recently, therapeutic development in psychiatry was targeted solely toward symptom reduction. While this is a worthwhile goal, it has yielded little progress in improved therapeutics in the last several decades in the field of mood disorders. Recent advancements in our understanding of pathophysiology suggests that an impairment of neuroplasticity may be a critical part of the development of neuropsychiatric disorders. Interventions that enhance or modulate neuroplasticity often reduce depressive symptoms when applied as stand-alone treatments. Unfortunately, when treatments are discontinued, the disease state often returns as patients relapse. However, treatments that enhance or modulate plasticity not only reduce symptom burden, but also may provide an opportune window wherein cognitive or behavioral interventions could be introduced to harness a state of enhanced neuroplasticity and lead to improved longer-term clinical outcomes. Here, we review the potential of synergistically combining plasticity-enhancing and behavioral therapies to develop novel translational treatment approaches for depression. After reviewing relevant neuroplasticity deficits in depression, we survey biological treatments that appear to reverse such deficits in humans, including N-methyl-D-aspartate receptor modulators (ketamine, D-cycloserine), electroconvulsive therapy, and transcranial brain stimulation. We then review evidence that either directly or indirectly supports the hypothesis that a robust enhancement of neuroplasticity through these methods might promote the uptake of cognitive and behavioral interventions to enhance longer-term treatment outcomes through a synergistic effect. We identify key missing pieces of evidence and discuss future directions to enhance this emerging line of research.

Associations between depression, anxious arousal and manifestations of psychological inflexibility

BACKGROUND AND OBJECTIVES

Psychological inflexibility exhibits across multiple facets of functioning, including thinking styles, personality, cognitive shifting, emotion, and physiology, with many of these manifestations showing associations with depression. As such, these facets might be part of an overarching latent construct of psychological inflexibility that explains associations with depression. We predicted that (1) five facets of inflexibility (perseverative thinking, personality rigidity, attention-shifting, negative emotional inertia, and low respiratory sinus arrhythmia reactivity) would load onto a unique latent construct of psychological inflexibility. Further, we hypothesized this latent construct of psychological inflexibility would be (2) significantly associated with higher depression; and (3) associated with depression to a greater extent than anxious arousal.

METHODS

Seventy-five adult community participants completed measures assessing the five indices of inflexibility and self-report measures of depression and anxious arousal.

RESULTS

Structural equation modeling identified a latent inflexibility construct reflected by perseverative thinking, personality rigidity, and emotional inertia, but did not include attention-shifting or RSA reactivity. The inflexibility construct was positively associated with depression and anxious arousal, but more strongly associated with depression than with anxious arousal.

LIMITATIONS

Limitations included a small sample size, cross-sectional approach, and dimensional measures of depression and anxious arousal.

CONCLUSIONS

Findings provide preliminary support that multiple facets of inflexibility may emerge from a broader overarching vulnerability for internalizing psychopathology. This overarching inflexibility construct may have stronger associations with depression than with anxious arousal.

Estrogen, Stress, and Depression: Cognitive and Biological Interactions

This article reviews the interactions of estrogen changes and psychosocial stress in contributing to vulnerability to major depressive disorder (MDD) in women. Estrogen modulates brain networks and processes related to changes in stress response, cognition, and emotional dysregulation that are core characteristics of MDD. Synergistic effects of estrogen on cognitive and emotional function, particularly during psychosocial stress, may underlie the association of ovarian hormone fluctuation and depression in women. We propose a model of estrogen effects on multiple brain systems that interface with stress-related emotional and cognitive processes implicated in MDD and discuss possible mechanisms through which reproductive events and changes in estrogen may contribute to MDD risk in women with other concurrent risk factors.

Can't look Away: Attention control deficits predict Rumination, depression symptoms and depressive affect in daily Life

BACKGROUND

Rumination and a reduced capacity to disengage attention as appropriate to context (attention control deficits) have each been implicated in the etiology and maintenance of depressive disorders. However, it remains unclear whether rumination is a mechanism by which attention control deficits predict depression, and whether these relations are observed outside of laboratory settings. We tested whether rumination mediates the effects of attention control deficits marked by slow disengagement from negative-valenced stimuli (sad faces) and fast disengagement from positive-valenced stimuli (happy faces) on depression symptoms and depressive affects in the daily lives of adults with various depression histories.

METHOD

Forty-six participants (n = 23 with histories of Major Depressive Disorder) completed a clinical evaluation, an eye-tracking task that indexed attention control, and a 7-day Ecological Momentary Assessment (EMA) follow-up during which Negative (NA) and Positive Affect (PA) were measured at times of peak distress that occurred in the hour preceding each EMA prompt.

RESULTS

Delayed disengagement from sad faces predicted elevated depression and NA levels, and low PA levels, independent of depression histories. Rumination mediated the effects of delayed disengagement from sad, and rapid disengagement from happy, faces on depression and NA levels. Effects of disengagement on rumination were maintained independent of depression levels.

LIMITATIONS

Our sample size limited the detection of small statistical effects, and we could not clarify temporal relationships between attention control deficits and rumination.

CONCLUSION

Our findings suggest that attention inflexibility and rumination persist independent of depressive states and should be targets of clinical intervention.

Anxiety and anhedonia in depression: Associations with neuroticism and cognitive control

BACKGROUND

Despite the fact that higher levels of anxiety and anhedonia in Major Depressive Disorder (MDD) are linked to poorer treatment outcomes, mechanisms contributing to these clinical presentations remain unclear. Neuroticism, impaired cognitive control, and blunted reward learning may be critical processes involved in MDD and may help to explain symptoms of anxiety and anhedonia.

METHODS

Using baseline data from patients with early-onset MDD (N = 296) in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial, we conducted a path analysis to model relationships between neuroticism, cognitive control, and reward learning to levels of anxiety and anhedonia.

RESULTS

Neuroticism was positively associated with both anhedonia (standardized coefficient = 0.26, p < .001) and anxiety (standardized coefficient = 0.40, p < .001). Cognitive control was negatively associated with anxiety (standardized coefficient = -0.18, p < .05). Reward learning was not significantly associated with either anxiety or anhedonia.

LIMITATIONS

Extraneous variables not included in the model may have even more influence in explaining symptoms of anxiety and anhedonia. Restricted range in these variables may have attenuated some of the hypothesized relationships. Most important, because this was a cross-sectional analysis in a currently depressed sample, we cannot draw any causal conclusions without experimental and longitudinal data.

CONCLUSIONS

These cross-sectional findings suggest that neuroticism may contribute to anxiety and anhedonia in patients with early onset and either chronic or recurrent MDD, while enhanced cognitive control may protect against anxiety.

Combining attentional bias modification with dorsolateral prefrontal rTMS does not attenuate maladaptive attentional processing

High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce depressive symptoms and improve cognitive biases such as attentional bias. One promising technique that may complement rTMS treatment is attentional bias modification (ABM) training, given the similarity in modulating attentional bias and affecting neuronal activity. We tested whether the combination of rTMS treatment and ABM training in a single session would attenuate maladaptive attentional processing and improve mood in participants with subclinical depressive symptoms. To this end, 122 healthy participants were randomly assigned to one of four groups, receiving either a single rTMS treatment, a single ABM treatment, a combination of rTMS and ABM or a sham treatment. Of these 122 participants, 72 showed a heightened BDI-II score (between 9 and 25) and were included in our main analyses. In our subclinical (≥9 and ≤25 BDI-II) sample, a single combination treatment of rTMS and ABM training induced no significant changes in attentional bias, attentional control or mood, nor did rTMS alone affect attentional bias systematically. We discuss these null findings in light of the task specifics and relate them to the ongoing discussion on ABM training in depression.

Attachment avoidance and fearful prosodic emotion recognition predict depression maintenance

Insecure attachment cognitions, emotion recognition biases, and their interaction are important contributors to depression susceptibility. The present study, with a prospective longitudinal design, investigated the role of negative emotion recognition in moderating the linkage from insecure attachment cognitions to elevated depressive symptoms. A sample of 96 depression-prone individuals completed measures for attachment anxiety and attachment avoidance, depression symptom severity, and a computerized facial and prosodic emotion recognition task twice with a four-week interval. Results revealed that the interaction between attachment avoidance and fearful prosodic emotion recognition significantly predicted subsequent depressive symptoms. More specifically, greater attachment avoidance with lower accuracy of fearful prosodic emotions at baseline predicted an increase of depressive symptoms over four-week interval. However, no moderating role of emotion recognition in the linkage from attachment anxiety to depression persistence was noted. The present study demonstrates that attachment avoidance and negative emotion recognition may together contribute to the maintenance of depression. The findings may be pertinent to attachment avoidance-related deactivating strategy that appears to be a specific cultural forbearance way for emotion regulation in collectivistic societies. Potential applications and future research are then suggested.

Attentional bias modification reduces clinical depression and enhances attention toward happiness

Difficulty in clinical antidepressant treatment leads to the pursuit of alternative treatments, such as cognitive-behavior therapy (CBT). CBT combined with regular antidepressants have indicated an optimal therapeutic effect in clinic. Attentional bias is important in the occurrence and remission of depression, however, few studies have explored the effect of attentional bias modification (ABM) on depression, and inconsistent results have been obtained due to the heterogeneity in the targeted populations, training tasks, strategies, and materials. Hence, the current study aimed to explore the therapeutic effect of ABM on depression in clinical depression. Study I was designed to explore the optimal training methods regarding task (dot-probe vs. cue-target), material (faces vs. self-referent words), and strategy (mixed ABM toward positive and away from negative stimuli vs. positive ABM toward positive stimuli) in unselected undergraduates once daily for 10 days (N = 309). Study II was carried out to observe the effect of 10 days ABM toward positive and away from negative faces (based on Study I) on clinical depression (N = 32). Depression level was assessed via a self-reporting questionnaire and a structured interview, while attentional bias was tested by cue-target task and attention to positive and negative inventory (APNI). In unselected undergraduates (Study I), two strategies significantly reduced the self-reporting depression scores: mixed ABM toward positive stimuli and away from negative stimuli with emotional faces, and positive ABM toward positive materials only with self-referent words. In patients with major depressive disorder (MDD) (Study II), the mixed ABM with emotional faces resulted in enhanced attentional bias toward happy materials in the cue-target task and APNI, which predicted a delayed depression reduction in clinical depression at the one-month follow-up investigation. Our finding confirms the literature and broadens the knowledge with the evidence of the optimal therapeutic effect of ABM combined with regular antidepressants in clinical depression. The findings that a quick enhancement in positive attentional bias, predicting a later therapeutic effect on clinical depression reduction, indicate a potential mechanism that could underlie the therapeutic process of ABM in depression. The findings that two training strategies are effective in depression reduction suggest that different strategies should be utilized to treat different types of depression. This study offers a potential way to cure depression and could be further practiced in clinic.

Cognitive and attentional vulnerability to depression in youth: A review

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

‘You feel like you haven’t got any control’: A qualitative study of side effects from medicines

Objectives

An aging UK population and multi-morbidity means patients are receiving an increasing number of medicines. This can lead to greater risk of unintended side effects. The aim of this study was to increase understanding of how people identify and manage side effects from their medicines.

Design

A qualitative interview study with patients who had experienced side effects, recruited from community pharmacies.

Methods

This study examined patients’ experiences of side effects and the impact of these effects on their daily life. Fifteen participants were interviewed – 10 females and 5 males, with ages that ranged between 25 and 80 years, using different types and numbers of medicines.

Results

Thematic analysis revealed six themes: side effect experience, identification, adherence, information use, coping and body awareness. Participants described a wide range of physical and psychological symptoms which had both explicit and implicit impact on their lives. A system of identification based on constructed cognitive processes was common across participants. A variety of strategies were used by participants to cope with their side effects which included information seeking, social support seeking and non-adherent behaviours.

Conclusions

Psychological factors, such as medication beliefs, symptom interpretation and body awareness, contribute to cognitive and behavioural processes used to identify and manage side effects. These processes can have significant impacts on an individual’s decisions about adherence.

Predictive value of attentional bias for the recurrence of depression: A 4-year prospective study in remitted depressed individuals

Previous research showed that individuals who were remitted from a depressive disorder displayed heightened attention towards negative adjectives (e.g., worthless). We tested if this attentional bias (AB) is predictive of future recurrence of depressive episodes and/or having depressive symptoms at 2- and 4-year follow-up. We used a longitudinal approach within the Netherlands Study of Depression and Anxiety (NESDA) and selected participants who were remitted from Major Depressive Disorder (MDD) (n = 918). AB was measured with a verbal Exogenous Cueing Task; using 2 presentation times (500 and 1250 ms) and 3 stimulus types (negative, positive, neutral). Over 4 years, we prospectively assessed recurrence of depressive episodes and depressive symptomatology after participants completed the ECT. Diagnosis of depressive disorder was measured with clinical rating-scales and self-report questionnaires. A heightened probability of recurrence was neither associated with (heightened) AB for negative nor with (lowered) AB for positive adjectives. Thus, the findings do not support the view that an AB toward negative stimuli or away from positive stimuli plays a critical role in the recurrence of depression.

Emotional Biases and Recurrence in Major Depressive Disorder. Results of 2.5 Years Follow-Up of Drug-Free Cohort Vulnerable for Recurrence

An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of emotional stimuli/information. Negatively biased processing of emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation biases in recurrently depressed patients in remission and relate these biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35-65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent biases with an emotional categorization task, bias in emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed biases toward emotionally negative stimuli, faster responses to negative self-relevant characteristics in the emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < p < 0.05). Of these, the number of misclassifications as angry and the overall performance in the emotional memory task were significantly associated with the time to recurrence (p ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided p = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) emotional bias when patients with recurrent depression are in remission. Moreover, these persisting biases might be mechanistically important for recurrence and prevention thereof.

Altered Working Memory Processing of Emotion in Adolescents with Dysphoric Symptomatology: An Eye Tracking Study

It has been suggested that altered processing of emotion during cognitive control plays an important role in the etiology of depressive symptoms. The current study investigates the influence of emotional stimuli on working memory (WM) in adolescents with dysphoric symptomatology (DS). Twenty-five adolescents with DS and 40 adolescents with no dysphoric symptomatology (NDS) completed a memory-guided eye movement task. This task assessed the influence of irrelevant affective information on WM processes during high and low cognitive load. Latency analyses showed that, in the high load WM condition, negative distractors disturbed WM performance in adolescents with NDS, but not in adolescents with DS. Accuracy analyses revealed that adolescents with NDS had higher accuracy rates in the presence of positive distractors relative to negative and neutral distractors, and in comparison to adolescents with DS. The findings indicated altered WM performance in the context of emotional distractors in adolescents with DS and may contribute to theoretical knowledge and early prevention of youth depression.

The causal role of selective attention for thin-ideal images on negative affect and rumination

BACKGROUND AND OBJECTIVES

Attentional bias towards thin-ideal body images has been implicated as a vulnerability factor for eating disorder symptomatology. However, the nature and causal basis of its relationship with other cognitive vulnerability factors, namely, eating disorder-specific rumination and negative mood, remains unclear. Accordingly, the current study investigated the causal influence of attentional bias towards thin-ideal images on emotional and ruminative vulnerability, in response to a body image-related stressor.

METHODS

An established attentional bias modification (ABM) procedure, the modified dot probe task, was used for the assessment and manipulation of attentional bias. Female undergraduate students (N = 110) aged between 17 and 24 years were randomly assigned to either 'attend' towards or 'avoid' thin-ideal images. Pre- and post-attentional training, participants completed the dot probe task, as well as state measures of rumination and negative mood. Additionally, following post-ABM assessment of attentional bias, participants were given a body image-related stressor.

RESULTS

Results showed that participants trained to attend to thin bodies reported heightened negative mood, in response to the stressor, compared with participants trained to avoid thin bodies. On the other hand, groups did not demonstrate a differential increase in eating disorder-specific rumination in response to the stressor.

LIMITATIONS

The current findings will require replication with clinical samples. Additionally, state rumination and negative mood were assessed via single items.

CONCLUSIONS

These results provide the first causal evidence for the role of attentional bias towards thin-ideal images in negative emotional vulnerability. Importantly, these results suggest attentional bias may serve as a risk factor for mood reactivity and a potential target for strategies designed to enhance emotional resilience.

Attentional bias modification treatment for depression: Study protocol for a randomized controlled trial

Theoretical models and empirical research point to negatively biased attention as a maintaining factor in depression. Although preliminary studies suggest experimentally modifying attentional biases (i.e., attentional bias modification; ABM) reduces depression symptoms and depression risk, relatively few rigorous studies with clinical samples have been completed. This clinical trial examines the impact of ABM on a sample of adults (N = 123) with elevated depression severity who also exhibit at least modest levels of negatively biased attention prior to treatment. Participants will be randomly assigned to either active ABM, placebo ABM, or an assessment-only control condition. Individuals assigned to ABM will complete 5 trainings per week (2 in-clinic, 3 brief trainings at-home) during a four-week period. Throughout this four-week period, participants will complete weekly assessments of symptom severity and putative treatment mediators measured across different levels of analysis (e.g., eye tracking, behavioral measures, and functional Magnetic Resonance Imaging). This article details the rationale and design of the clinical trial, including methodological issues that required more extensive consideration. Our findings may not only point to an easily-accessible, efficacious treatment for depression but may also provide a meaningful test of whether a theoretically important construct, negatively biased attention, maintains depression.

Preschool Executive Function Predicts Childhood Resting-State Functional Connectivity and Attention-Deficit/Hyperactivity Disorder and Depression

BACKGROUND

Measures of executive function (EF), such as the Behavior Rating Inventory of Executive Function, distinguish children with attention-deficit/hyperactivity disorder (ADHD) from control subjects, but less work has examined relationships to depression or brain network organization. This study examined whether early childhood EF predicted new onset or worsening of ADHD and/or depression and examined how early childhood EF related to functional connectivity of brain networks at school age.

METHODS

Participants included 247 children who were enrolled at 3 to 6 years of age from a prospective study of emotion development. The Behavior Rating Inventory of Executive Function Global Executive Composite score was used as the measure of EF in early childhood to predict ADHD and depression diagnoses and symptoms across school age. Resting-state functional magnetic resonance imaging network analyses examined global efficiency in the frontoparietal, cingulo-opercular, salience, and default mode networks and six "hub" seed regions selected to examine between-network connectivity.

RESULTS

Early childhood EF predicted new onset and worsening of ADHD and depression symptoms across school age. Greater EF deficits in preschool predicted increased global efficiency in the salience network and altered connectivity with four regions for the dorsal anterior cingulate cortex hub and one region with the insula hub at school age. This altered connectivity was related to increasing ADHD and depression symptoms.

CONCLUSIONS

Early executive deficits may be an early common liability for risk of developing ADHD and/or depression and were associated with altered functional connectivity in networks and hub regions relevant to executive processes. Future work could help clarify whether specific EF deficits are implicated in the development of both disorders.

Attentional bias for negative, positive, and threat words in current and remitted depression

Background

The aim of this study was to improve our understanding of the underlying mechanisms in the maintenance of depression. We examined attentional bias (AB) for negative and positive adjectives and general threat words in strictly-defined clinical groups of participants with pure Major Depressive Disorder (MDD) without a history of anxiety disorders (AD), mixed MDD and AD, and remitted participants.

Method

We investigated both stimulus specificity and time course of AB in these groups, adopting a cross-sectional design. Data were drawn from the large scale Netherlands Study of Depression and Anxiety (NESDA), from which we selected all participants with pure current MDD without a history of AD (n = 29), all participants with current MDD and co-morbid AD(s) (n = 86), all remitted MDD participants (n = 294), and a comparison group without (a history of) MDD or ADs (n = 474). AB was measured with an Exogenous Cueing Task covering short and long presentation times (500 and 1250 ms) and 4 stimulus types (negative, positive, threat, neutral).

Results

Both traditional and trial level (dynamic) AB scores failed to show an AB for negative adjectives in participants with MDD or mixed MDD/AD. Specifically for long duration trials (1250 ms), remitted participants showed a larger AB traditional score (albeit the actual score still being negative) than the comparison group. The mixed MDD/AD group showed a higher trial-level AB score away from positive adjectives (1250 ms) than the comparisons. In addition, the mixed MDD/AD group showed higher and more variable trial-level AB scores away from short and towards longer presented general threat words together with a non-significant tendency to show less negative traditional AB scores for threat trials (500 ms) than the comparison group.

Conclusions

All in all, the findings do not corroborate the view that an AB towards negative or away from positive adjectives is critically involved in currently depressed individuals. Yet, the relatively high (less negative) AB score for negative adjectives in remitted individuals points to the possibility that an AB for negative information may be involved as a risk factor in the recurrence of MDD.

Cognitive bias modification as an add-on treatment in clinical depression: Results from a placebo-controlled, single-blinded randomized control trial

BACKGROUND

Only 60% of depressed patients respond sufficiently to treatment, so there is a dire need for novel approaches to improve treatment effects. Cognitive Bias Modification (CBM) may be an effective and easily implemented computerized add-on to treatment-as-usual. Therefore, we investigated the effects of a positivity-attention training and a positivity-approach training compared to control trainings.

METHODS

In a blinded randomized-controlled design, 139 depressed inpatients received either the CBM Attention Dot-Probe Training (DPT) or the CBM Approach-Avoidance Training (AAT), next to treatment as usual. N = 121 finished all four training sessions. Both trainings had an active and a control condition. In both active conditions, patients were trained to preferentially process generally positive pictures over neutral pictures. Depressive symptom severity was assessed before and after CBM, and positivity bias was measured at the start and end of each session.

RESULTS

Clinician-rated depressive symptom severity decreased more in patients who received the active condition of the DPT or the AAT compared to patients in the control conditions. Significant change in positivity bias was found for the DPT (not the AAT), but did not mediate the effect of the training on depressive symptoms.

CONCLUSIONS

The results suggest that both types of CBM (i.e., DPT and AAT) may provide a fitting add-on treatment option for clinical depression. The working mechanisms and optimal dose of CBM trainings, plus their possible combination, should be examined in more detail.

Attentional bias in MDD: ERP components analysis and classification using a dot-probe task

BACKGROUND AND OBJECTIVE

Strands of evidence have supported existence of negative attentional bias in patients with depression. This study aimed to assess the behavioral and electrophysiological signatures of attentional bias in major depressive disorder (MDD) and explore whether ERP components contain valuable information for discriminating between MDD patients and healthy controls (HCs).

METHODS

Electroencephalography data were collected from 17 patients with MDD and 17 HCs in a dot-probe task, with emotional-neutral pairs as experimental materials. Fourteen features related to ERP waveform shape were generated. Then, Correlated Feature Selection (CFS), ReliefF and GainRatio (GR) were applied for feature selection. For discriminating between MDDs and HCs, k-nearest neighbor (KNN), C4.5, Sequential Minimal Optimization (SMO) and Logistic Regression (LR) were used.

RESULTS

Behaviorally, MDD patients showed significantly shorter reaction time (RT) to valid than invalid sad trials, with significantly higher bias score for sad-neutral pairs. Analysis of split-half reliability in RT indices indicated a strong reliability in RT, while coefficients of RT bias scores neared zero. These behavioral effects were supported by ERP results. MDD patients had higher P300 amplitude with the probe replacing a sad face than a neutral face, indicating difficult attention disengagement from negative emotional faces. Meanwhile, data mining analysis based on ERP components suggested that CFS was the best feature selection algorithm. Especially for the P300 induced by valid sad trials, the classification accuracy of CFS combination with any classifier was above 85%, and the KNN (k = 3) classifier achieved the highest accuracy (94%).

CONCLUSIONS

MDD patients show difficulty in attention disengagement from negative stimuli, reflected by P300. The CFS over other methods leads to a good overall performance in most cases, especially when KNN classifier is used for P300 component classification, illustrating that ERP component may be applied as a tool for auxiliary diagnosis of depression.

Free viewing of sad and happy faces in depression: A potential target for attention bias modification

BACKGROUND

Identification of reliable targets for therapeutic interventions is essential for developing evidence-based therapies. Attention biases toward negative-valenced information and lack of protective positive bias toward positive-valenced stimuli have been implicated in depression. However, extant research has typically used tasks with narrow stimuli arrays and unknown or poor psychometric properties. Here, we recorded eye-tracking data of depressed and non-depressed participants during a free viewing task to address these limitations.

METHODS

Patients with major depressive disorder (MDD; n = 20) and undergraduate students with high (n = 23) and low (n = 20) levels of depression freely viewed 60 different face-based matrices for six seconds each. Each matrix included eight sad and eight happy facial expressions. Gaze patterns on sad and happy areas of interest (AOIs) were explored. Internal consistency for the entire sample and one-week test-retest reliability in the student sub-sample were assessed.

RESULTS

Compared to undergraduates with low levels of depression, patients with MDD and students with high levels of depression dwelled significantly longer on sad faces. Results also showed a significantly longer dwell time on the happy AOI relative to the sad AOI only in the low depression group. The two depressed groups dwelled equally on the two AOIs. The task demonstrated high internal consistency and acceptable one-week test-retest reliability.

LIMITATIONS

Only sad and happy facial expressions were used. Relative small sample size.

CONCLUSION

Relative to non-depressed participants, depressed participants showed prolonged dwelling on sad faces and lack of bias toward happy faces. These biases present viable targets for gaze-contingent attention bias modification therapy.

Attention Bias in Rumination and Depression: Cognitive Mechanisms and Brain Networks

Depressed individuals exhibit biased attention to negative emotional information. However, much remains unknown about (1) the neurocognitive mechanisms of attention bias (e.g., qualities of negative information that evoke attention bias, or functional brain network dynamics that may reflect a propensity for biased attention) and (2) distinctions in the types of attention bias related to different dimensions of depression (e.g., ruminative depression). Here, in 50 women, clinical depression was associated with facilitated processing of negative information only when such information was self-descriptive and task-relevant. However, among depressed individuals, trait rumination was associated with biases towards negative self-descriptive information regardless of task goals, especially when negative self-descriptive material was paired with self-referential images that should be ignored. Attention biases in ruminative depression were mediated by dynamic variability in frontoinsular resting-state functional connectivity. These findings highlight potential cognitive and functional network mechanisms of attention bias specifically related to the ruminative dimension of depression.

Longitudinal Relations Between Depressive Symptoms and Executive Functions From Adolescence to Early Adulthood: A Twin Study

Depression is associated with deficits in executive functions (EFs)-cognitive control abilities that regulate goal-directed thoughts and actions-but the etiology of these associations is unclear. We examined the relations between depressive symptoms and multiple EF latent variables in a population-based sample of 439 twin pairs assessed at mean ages 12, 17, and 23 years. Greater depressive symptoms negatively related to a Common EF factor capturing shared variance across response inhibition, working memory updating, and mental set shifting tasks, and also negatively related to an Updating-Specific factor, but not a Shifting-Specific factor. Cross-lagged panel models suggested that the Common EF correlations reflected within-wave associations rather than prospective effects, whereas the Updating-Specific correlations reflected associations of earlier depression levels with later Updating-Specific ability. Twin models were consistent with a model in which Common EF and Updating-Specific abilities relate to depression through correlated genetic risk, with no significant environmental correlations.

One MRI-compatible tDCS session attenuates ventromedial cortical perfusion when exposed to verbal criticism: The role of perceived criticism

Transcranial direct current stimulation (tDCS) is a potential treatment strategy for mood and anxiety disorders, but how this application may influence emotional processes, and whether this is related to individual characteristics, is not well understood. It has been proposed that perceived criticism (PC) may represent a vulnerability factor for the development of such mental illnesses. To decipher whether neural mechanisms of action of tDCS potentially differ depending on PC status (low vs. high), we evaluated mood and brain perfusion before and after applying MRI-compatible tDCS, and after participants were exposed to verbal criticism in the scanner. Experimental design 30 healthy nondepressed females were included in a sham-controlled crossover MRI-compatible tDCS study. Brain perfusion was measured by means of arterial spin labeling (ASL) before and after tDCS applied to the left dorsolateral prefrontal cortex (DLPFC), and after hearing criticism. Before the experiment, all participants provided a rating of PC in their closest environment. Principal observations at the behavioral level, criticism made participants angrier. This was unrelated to the active or sham stimulation. After being criticized, females scoring high on PC had significantly decreased brain perfusion in the pregenual anterior cingulate cortex (pgACC) and medioprefrontal cortex (mPFC), after active tDCS but not sham. The decrease in pgACC/mPFC perfusion points to a significant impact of tDCS in brain areas related to stress responses and self-referential processes, especially in females scoring high on PC, which has been shown to be related to vulnerability for mood and anxiety disorders.

Negative self-referential processing is associated with genetic variation in the serotonin transporter-linked polymorphic region (5-HTTLPR): Evidence from two independent studies

The current research examined whether carriers of the short 5-HTTLPR allele (in SLC6A4), who have been shown to selectively attend to negative information, exhibit a bias towards negative self-referent processing. The self-referent encoding task (SRET) was used to measure self-referential processing of positive and negative adjectives. Ratcliff's diffusion model isolated and extracted decision-making components from SRET responses and reaction times. Across the initial (N = 183) and replication (N = 137) studies, results indicated that short 5-HTTLPR allele carriers more easily categorized negative adjectives as self-referential (i.e., higher drift rate). Further, drift rate was associated with recall of negative self-referential stimuli. Findings across both studies provide further evidence that genetic variation may contribute to the etiology of negatively biased processing of self-referent information. Large scale studies examining the genetic contributions to negative self-referent processing may be warranted.

Mindfulness, Interpretation Bias, and Levels of Anxiety and Depression: Two Mediation Studies

In two studies, a possible mediation effect was tested of cognitive interpretation bias in the relation between respectively dispositional mindfulness and acceptance, on the one hand, and symptoms of depression and anxiety, on the other hand. An undergraduate student sample (N = 133; 86% female, M age = 19.8) and a convenience community sample (N = 186; 66% female, M age = 36.5) were examined by means of an online questionnaire measuring dispositional mindfulness (FFMQ-SF; Study 1) and acceptance (AAQ-II; Study 2), anxiety (STAI-trait) and depressive (BDI-II) symptoms, and interpretation bias (with the interpretation bias task, IBT). Considering both studies, results showed consistently the expected relations of larger mindfulness skills going together with a smaller cognitive interpretation bias and lower levels of depression and anxiety symptoms. More interestingly, it was found that interpretation bias served as a mediator in the relations between respectively dispositional mindfulness and acceptance, and symptoms of depression and anxiety. With these findings, some more insight in the working mechanisms of mindfulness-based treatments on internalizing psychopathology has been obtained.

Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis

BACKGROUND

The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low.

OBJECTIVE

The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements.

METHODS

We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach.

RESULTS

Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists.

CONCLUSIONS

The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression.

Memory bias toward emotional information in burnout and depression

A sample of 1015 educational staff members, exhibiting various levels of burnout and depressive symptoms, underwent a memory test involving incident encoding of positive and negative words and a free recall task. Burnout and depression were each found to be associated with increased recall of negative items and decreased recall of positive items. Results remained statistically significant when controlling for history of depressive disorders. Burnout and depression were not related to mistakes in the reported words, or to the overall number of recalled words. This study suggests that burnout and depression overlap in terms of memory biases toward emotional information.

Automatic approach-avoidance tendencies as a candidate intermediate phenotype for depression: Associations with childhood trauma and the 5-HTTLPR transporter polymorphism

Depression risk genes in combination with childhood events have been associated with biased processing as an intermediate phenotype for depression. The aim of the present conceptual replication study was to investigate the role of biased automatic approach-avoidance tendencies as a candidate intermediate phenotype for depression, in the context of genes (5-HTTLPR polymorphism) and childhood trauma. A naturalistic remitted depressed patients sample (N = 209) performed an Approach-Avoidance Task (AAT) with facial expressions (angry, sad, happy and neutral). Childhood trauma was assessed with a questionnaire. Genotype groups were created based on allele frequency: L_aL_a versus S/L_g-carriers. The latter is associated with depression risk. We found that remitted S/L_g-carriers who experienced childhood trauma automatically avoided sad facial expressions relatively more than L_aL_a homozygotes with childhood trauma. Remitted L_aL_a-carriers who had not experienced childhood trauma, avoided sad faces relatively more than L_aL_a homozygotes with childhood trauma. We did not find a main effect of childhood trauma, nor differential avoidance of any of the other facial expressions. Although tentative, the results suggest that automatic approach-avoidance tendencies for disorder-congruent materials may be a fitting intermediate phenotype for depression. The specific pattern of tendencies, and the relation to depression, may depend on the genetic risk profile and childhood trauma, but replication is needed before firm conclusions can be drawn.

vmPFC activation during a stressor predicts positive emotions during stress recovery

Despite accruing evidence showing that positive emotions facilitate stress recovery, the neural basis for this effect remains unclear. To identify the underlying mechanism, we compared stress recovery for people reflecting on a stressor while in a positive emotional context with that for people in a neutral context. While blood-oxygen-level dependent data were being collected, participants (N = 43) performed a stressful anagram task, which was followed by a recovery period during which they reflected on the stressor while watching a positive or neutral video. Participants also reported positive and negative emotions throughout the task as well as retrospective thoughts about the task. Although there was no effect of experimental context on emotional recovery, we found that ventromedial prefrontal cortex (vmPFC) activation during the stressor predicted more positive emotions during recovery, which in turn predicted less negative emotions during recovery. In addition, the relationship between vmPFC activation and positive emotions during recovery was mediated by decentering-the meta-cognitive detachment of oneself from one's feelings. In sum, successful recovery from a stressor seems to be due to activation of positive emotion-related regions during the stressor itself as well as to their downstream effects on certain cognitive forms of emotion regulation.

Attentional biases in patients suffering from unipolar depression: results of a dot probe task investigation

Cognitive models of depression emphasize the relevance of cognitive biases for development, onset and maintenance of major depressive disorder (MDD). Attentional biases consisting of increased attention to negative, mood congruent stimuli and reduced attention to positive, mood-incongruent stimuli are postulated but have rarely been tested for early attentional processing. Furthermore, the role of concurrent depressive mood as a moderating factor has not been studied to date. Participants comprised 30 patients suffering from MDD and 30 healthy control subjects. All participants performed a dot-probe task with pictorial stimuli displaying affective facial expressions, presented either for 100ms or for 500ms. Attentional biases towards faces displaying joy in both MDD patients and control subjects and towards faces displaying pain in MDD subjects were found at presentation times of 100ms. In the MDD sample, the bias indices at 100ms were correlated with concurrent depressive mood. In patients with pronounced depressive mood, significant biases towards happy and angry faces were observed that exceed the biases obtained in control subjects and patients with less depressive mood. The results provide first evidence that MDD patients with pronounced depressive mood show an increased early attentional engagement towards emotional salient stimuli, independent from valence.

Deconstructing trait anxiety: a network perspective

BACKGROUND AND OBJECTIVES

For decades, the dominant paradigm in trait anxiety research has regarded the construct as signifying the underlying cause of the thoughts, feelings, and behaviors that supposedly reflect its presence. Recently, a network theory of personality has appeared. According to this perspective, trait anxiety is a formative construct emerging from interactions among its constitutive features (e.g., thought, feelings, behaviors); it is not a latent cause of these features.

DESIGN

In this study, we characterized trait anxiety as a network system of interacting elements.

METHODS

To do so, we estimated a graphical gaussian model via the computation of a regularized partial correlation network in an unselected sample (N = 611). We also implemented modularity-based community detection analysis to test whether the features of trait anxiety cohere as a single network system.

RESULTS

We find that trait anxiety can indeed be conceptualized as a single, coherent network system of interacting elements.

CONCLUSIONS

This radically new approach to visualizing trait anxiety may offer an especially informative view of the interplay between its constitutive features. As prior research has implicated trait anxiety as a risk factor for the development of anxiety-related psychopathology, our findings also set the scene for novel research directions.

A short educational intervention diminishes causal illusions and specific paranormal beliefs in undergraduates

Cognitive biases such as causal illusions have been related to paranormal and pseudoscientific beliefs and, thus, pose a real threat to the development of adequate critical thinking abilities. We aimed to reduce causal illusions in undergraduates by means of an educational intervention combining training-in-bias and training-in-rules techniques. First, participants directly experienced situations that tend to induce the Barnum effect and the confirmation bias. Thereafter, these effects were explained and examples of their influence over everyday life were provided. Compared to a control group, participants who received the intervention showed diminished causal illusions in a contingency learning task and a decrease in the precognition dimension of a paranormal belief scale. Overall, results suggest that evidence-based educational interventions like the one presented here could be used to significantly improve critical thinking skills in our students.

The impact of happy and angry faces on working memory in depressed adolescents

Recent cognitive models suggest that the ability to control emotional information in working memory (WM) may be implicated in the etiology and maintenance of depression. However, few studies have examined the effects of processing relevant and irrelevant emotional stimuli on WM performance in depressed adolescents. In the current study, depressed adolescents (n = 27) and healthy adolescents (n = 49) completed two versions of an emotional n-back task: a low WM load (0-back) task and a high WM load (2-back) task. In the emotion-relevant condition participants were asked to attend to the emotional expression of an angry, happy, or neutral face, whereas in the emotion-irrelevant condition participants were asked to attend to the gender of the face. The results showed a WM improvement for happy faces in the emotion-relevant condition and a WM impairment for happy faces in the emotion-irrelevant condition for healthy adolescents but not for depressed adolescents. No biases toward angry faces were found. These results demonstrate that depressed adolescents do not show a preferential processing of angry faces but rather fail to show a positivity bias as seen in healthy adolescents. This supports the theoretical notion that a depressive disorder is characterized by a blunted reactivity toward positive information and may provide new insights into the underlying mechanisms of youth depression.

Self-face Captures, Holds, and Biases Attention

The implicit self-recognition process may take place already in the pre-attentive stages of perception. After a silent stimulus has captured attention, it is passed on to the attentive stage where it can affect decision making and responding. Numerous studies show that the presence of self-referential information affects almost every cognitive level. These effects may share a common and fundamental basis in an attentional mechanism, conceptualized as attentional bias: the exaggerated deployment of attentional resources to a salient stimulus. A gold standard in attentional bias research is the dot-probe paradigm. In this task, a prominent stimulus (cue) and a neutral stimulus are presented in different spatial locations, followed by the presentation of a target. In the current study we aimed at investigating whether the self-face captures, holds and biases attention when presented as a task-irrelevant stimulus. In two dot-probe experiments coupled with the event-related potential (ERP) technique we analyzed the following relevant ERPs components: N2pc and SPCN which reflect attentional shifts and the maintenance of attention, respectively. An inter-stimulus interval separating face-cues and probes (800 ms) was introduced only in the first experiment. In line with our predictions, in Experiment 1 the self-face elicited the N2pc and the SPCN component. In Experiment 2 in addition to N2pc, an attentional bias was observed. Our results indicate that unintentional self-face processing disables the top-down control setting to filter out distractors, thus leading to the engagement of attentional resources and visual short-term memory.