Dysphoria, attributional reasoning and future event probability

A behavioural test of depression-related probability bias

Individuals high in depressive symptom severity show probability bias: they believe negative events are relatively probable, and positive events relatively improbable, compared to those with less severe symptoms. However, this has only ever been demonstrated using self-report measures, in which participants explicitly estimate events' probabilities: this leaves open the risk that "probability bias" is merely an artefact of response bias. We tested the veracity of probability bias using an indirect behavioural measure, based on a sentence-reading task. Study 1 tested 112 Turkish students; Study 2 tested 117 international users of online groups for people with depressive and anxiety disorders. As predicted, participants with higher depressive symptom scores responded relatively quickly to sentences stating negative events might occur, and relatively slowly to sentences stating positive events might occur, compared to those with lower scores. This effect was only marginal in Study 1, but reached significance in Study 2. However, contrary to predictions, this effect was not moderated by the probability level stated in the sentence. This makes our findings difficult to interpret, and we must present these studies as a failure to convincingly demonstrate depression-related probability bias. We hope this stimulates more work on the nature and veracity of probability bias.

Probability, cost, and interpretation biases' relationships with depressive and anxious symptom severity: differential mediation by worry and repetitive negative thinking

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking - all involve thinking about potential threats and misfortunes - we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases' associations with depressive and anxious symptom severity. In three studies, conducted in two languages and cultures, cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective.

Self- and observer ratings of capacity limitations in patients with neurological conditions

OBJECTIVE

The purpose of this study was to compare the self- and observer ratings of capacity limitations in patients with neurological conditions. Research on this topic is relevant for assessing the patients' ability to participate in work and social life and improving collaborative patient-clinician relationships.

METHOD

The self- and observer ratings of capacity limitations in a sample of N = 245 patients with neurological conditions from a rehabilitation facility were compared and assessed using the short rating of activity limitations and participation restrictions in mental disorders according to the International Classification of Functioning, Disability and Health (Mini-ICF-APP) and the equivalent self-rating questionnaire (Mini-ICF-APP-S).

RESULTS

Paired-samples t-tests revealed significant differences between the self- and observer ratings for six out of 13 capacity dimensions. On average, the patients rated the capacity dimensions adherence to regulations, planning and structuring of tasks, professional competency and endurance as significantly less limited, in comparison to the observers (small to medium effect sizes). The self-ratings for limitation of contact with others and self-care were only marginally higher than the observer ratings.

CONCLUSIONS

The findings show that psychological capacity limitations occur in patients with neurological conditions. In clinical practice, limitations in each capacity dimension and discrepancies in patient- and clinician-ratings should be thoroughly assessed. This is especially relevant in patients with neurological conditions who have a potential tendency to underestimate or deny their disability.

Specificity of Future Thinking in Depression: A Meta-Analysis

Reduced specificity of autobiographical memory has been well established in depression, but whether this overgenerality extends to future thinking has not been the focus of a meta-analysis. Following a preregistered protocol, we searched six electronic databases, Google Scholar, and personal libraries and contacted authors in the field for studies matching search terms related to depression, future thinking, and specificity. We reduced an initial 7,332 results to 46 included studies, with 89 effect sizes and 4,813 total participants. Random-effects meta-analytic modeling revealed a small but robust correlation between reduced future specificity and higher levels of depression (r = -.13, p < .001). Of the 11 moderator variables examined, the most striking effects were related to the emotional valence of future thinking (p < .001) and the sex of participants (p = .025). Namely, depression was linked to reduced specificity for positive (but not negative or neutral) future thinking, and the relationship was stronger in samples with a higher proportion of males. This meta-analysis contributes to our understanding of how prospection is altered in depression and dysphoria and, by revealing areas where current evidence is inconclusive, highlights key avenues for future research.

Predictors of Symptom Outcome in Interpretation Bias Modification for Dysphoria

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

A review on future episodic thinking in mood and anxiety disorders

Future episodic thinking refers to the ability to imagine oneself in the future and project oneself into specific future events. This cognitive process is related to decision making and planning for the future. Although healthy populations commonly project themselves into the future (e.g. while planning a trip or career), patients with mood disorders show impairment in this ability. In this review article, we discuss the similarities and differences in future thinking among the following populations: major depressive disorder, dysphoria, anxiety, and post-traumatic stress disorder (PTSD). Importantly, we highlight the methodological variations in future episodic memory tasks in the literature that may explain the differences in the existing results.

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

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

Hostile interpretation bias in depression

BACKGROUND

Research suggests an important relationship between interpretation bias, hostility and Major Depressive Disorder (MDD). Extant literature has yet to examine hostile interpretation bias in clinically depressed samples; the current studies sought to fill this gap.

METHOD

Study 1 participants included undergraduates who met criteria for MDD (n=36) or no anxiety or mood diagnosis (n=35). Each participant completed a structured clinical interview along with measures of depression, hostile interpretation bias, and trait hostility. In Study 2, a sample of treatment-seeking individuals with elevated trait anger completed measures of depression, hostile interpretation bias, and trait anger.

RESULTS

Study 1 demonstrated that, relative to the non-depressed group, individuals with depression displayed greater hostile interpretation bias but comparable levels of trait hostility. In Study 2, greater hostile interpretation bias was associated with greater depressive symptoms, and this relationship was independent of co-occurring trait anger.

LIMITATIONS

The correlational nature of these studies precludes interpretation of causal relationships between constructs. Additionally, replication of these results should be sought in a larger, more diverse sample.

CONCLUSION

Overall, the findings suggest hostile interpretation bias may play a unique role in depression and could be a treatable feature of interpersonal mechanisms maintaining MDD.

Depression is related to an absence of optimistically biased belief updating about future life events

BACKGROUND

When challenged with information about the future, healthy participants show an optimistically biased updating pattern, taking desirable information more into account than undesirable information. However, it is unknown how patients suffering from major depressive disorder (MDD), who express pervasive pessimistic beliefs, update their beliefs when receiving information about their future. Here we tested whether an optimistically biased information processing pattern found in healthy individuals is absent in MDD patients.

METHOD

MDD patients (n = 18; 13 medicated; eight with co-morbid anxiety disorder) and healthy controls (n = 19) estimated their personal probability of experiencing 70 adverse life events. After each estimate participants were presented with the average probability of the event occurring to a person living in the same sociocultural environment. This information could be desirable (i.e. average probability better than expected) or undesirable (i.e. average probability worse than expected). To assess how desirable versus undesirable information influenced beliefs, participants estimated their personal probability of experiencing the 70 events a second time.

RESULTS

Healthy controls showed an optimistic bias in updating, that is they changed their beliefs more toward desirable versus undesirable information. Overall, this optimistic bias was absent in MDD patients. Symptom severity correlated with biased updating: more severely depressed individuals showed a more pessimistic updating pattern. Furthermore, MDD patients estimated the probability of experiencing adverse life events as higher than healthy controls.

CONCLUSIONS

Our findings raise the intriguing possibility that optimistically biased updating of expectations about one's personal future is associated with mental health.

The future is here: a review of foresight systems in anxiety and depression

Cognitive models of anxiety and depression have long suggested a central role for future-oriented thinking in these disorders. Experimental studies suggest that anxiety and depression are characterised by distinct future-oriented thinking profiles, and that these profiles are markedly different from those of asymptomatic adults. In this paper, we review these profiles and propose two explanatory models marked by two different neurocognitive systems. The Reconstructive Memory Model emphasises a role for emotionally driven learning and retrieval in episodic foresight (i.e., the construction of future-oriented scenarios), and the Valuation Model proposes that an overweighing of risk and uncertainty estimates can be invoked to explain the future-oriented thought patterns. We consider the effectiveness of interventions aimed at altering such thought patterns. We suggest that future research aimed at elucidating the neurobiological underpinnings of future-oriented thinking in anxiety and depression can play an important role in advancing development of effective biological and psychosocial interventions for these disorders.

Context insensitivity during positive and negative emotional expectancy in depression assessed with functional magnetic resonance imaging

Patients with depression show an enhanced preoccupation with negative expectations and are often unable to look forward to positive events. Here we studied anticipatory emotional processes in unmedicated depressed patients using functional magnetic resonance imaging. Consistent with a negative processing bias, we hypothesized enhanced responses to negative and attenuated responses to positive expectancy cues in brain areas associated with emotional expectancy. Participants comprised 19 drug-free depressed patients and 19 matched healthy control subjects who viewed affective photographs. Pictures were preceded by an expectancy cue which signaled the emotional valence of the upcoming picture in half of the trials. Depressed patients showed attenuated blood-oxygen-level-dependent responses in the left lateral prefrontal cortex (inferior frontal gyrus, Brodmann area 44) during positive expectancy and-contrary to our hypothesis-in the right lateral orbitofrontal cortex (middle frontal gyrus, Brodmann area 47) during negative expectancy. This attenuation was specific for the anticipation (as opposed to the perception) of emotional pictures and correlated with a clinical measure of depressive symptoms. The observed attenuation suggests emotion-context insensitivity rather than a negative processing bias during anticipatory emotional processes in depression. This hyporeactivity may contribute to clinical features like anergia, apathy, and loss of motivation in the context of both positive and negative incentives.

Functional neuroanatomy of emotion processing in major depressive disorder is altered after successful antidepressant therapy

Major Depressive Disorder (MDD) is associated with impaired processing and regulation of emotions. A vast body of research has elucidated the altered neural processes that occur in response to emotional stimuli, while little is known about anticipatory processes. Here we used functional magnetic resonance imaging (fMRI) to investigate neural activation during the presentation and anticipation of negative stimuli. Furthermore, we examined the effects of an 8-week antidepressant treatment with escitalopram. We matched 12 unmedicated MDD patients and 12 healthy control participants to perform a task involving affective pictures. The design of our event-related task consisted of presenting positive, negative, and neutral pictures from the International Affective Picture System (IAPS) across two runs and under opposite conditions. For the 'expected' condition, the pictures were cued by a word indicating their emotional valence; whereas the 'unexpected' condition had a combination of random letters precede the emotion picture. MDD patients displayed greater amygdala activation when anticipating negative pictures and greater prefrontal activation when confronted with them without the anticipatory cues. After antidepressant treatment, both amygdala and prefrontal activation decreased significantly in the treated MDD patients relative to controls. These findings show that the neural mechanisms of emotion anticipation and processing are altered in patients with MDD and that these alterations are able to normalize after treatment with an antidepressant.

Affective functioning among early adolescents at high and low familial risk for depression and their mothers: a focus on individual and transactional processes across contexts

This study aimed to characterize affective functioning in families of youth at high familial risk for depression, with particular attention to features of affective functioning that appear to be critical to adaptive functioning but have been underrepresented in prior research including: positive and negative affect across multiple contexts, individual and transactional processes, and affective flexibility. Interactions among early adolescents (ages 9-14) and their mothers were coded for affective behaviors across both positive and negative contexts. Primary analyses compared never-depressed youth at high (n = 44) and low (n = 57) familial risk for depression. The high risk group showed a relatively consistent pattern for low positive affect across negative and positive contexts at both the individual and transactional level. In contrast to prior studies focusing on negative contexts that did not support disruptions in negative affect among high risk youth, the data from this study suggest variability by context (i.e. increased negativity in a positive, but not negative, context), and individual vs. transactional processes (e.g., negative escalation). Findings are discussed in concert with attention to affect flexibility, contextual and transactional factors.

Modifying cognitive errors promotes cognitive well being: a new approach to bias modification

BACKGROUND

Cognitive Bias Modification (CBM) procedures have been used to train individuals to interpret ambiguous information in a negative or benign direction and have provided evidence that negative biases causally contribute to emotional vulnerability.

METHOD

Here we present the development and validation of a new form of CBM designed to manipulate the cognitive errors known to characterize both depression and anxiety. Our manipulation was designed to modify the biased cognitions identified by Beck's cognitive error categories (e.g. arbitrary inference, overgeneralisation) and typically targeted during therapy.

RESULTS

In a later test of spontaneous inferences, unselected (Experiment 1) and vulnerable participants (Experiment 2) who had generated positive alternatives rather than errors perceived novel hypothetical events, their causes and outcomes in a non-distorted manner. These groups were also less vulnerable to two different types of emotional stressor (video clips; and an imagined social situation). Furthermore participants' interpretation of their own performance on a problem-solving task was improved by the manipulation, despite actual performance showing no significant change.

CONCLUSIONS

These findings demonstrate that Cognitive Error Modification can promote positive inferences, reduce vulnerability to stress and improve self-perceptions of performance.

Decision making in depression: differences in decisional conflict between healthy and depressed individuals

This study investigated differences in the emergence of decisional conflict in healthy and depressed participants. The two groups of interest were questioned about their experience of decisional conflict and ongoing thoughts and impressions during decision making. As predicted, depressed participants experienced more decisional conflict than healthy participants. Furthermore, the diverse processes hypothesis was supported: In healthy participants, preoccupation with the task was the only predictor of decisional conflict. In depressed participants, decisional conflict was predicted by a combination of depression-related processes (e.g., low self-efficacy, lack of concentration, rumination, etc.). This research reduces the gap between the relevance of the symptom of indecisiveness (e.g., for diagnostic purposes) and the lack of knowledge in this realm of psychopathology.

Positive Affect Stimulation and Sustainment (PASS) Module for Depressed Mood: A preliminary investigation of treatment-related effects

Positive affective functioning (PAF) is critical to the development, course and treatment of depressive symptoms. Targeting key features of PAF during treatment may provide a new angle through which to improve affective functioning and reduce symptoms. The current study was a treatment development trial for the Positive Affect Stimulation and Sustainment (PASS) Module. PASS is conceptualized as a means of capitalizing on positive events (e.g. planned through behavioral activation) by enhancing and sustaining positive affective states through savoring, and establishing positive attributions and expectancies. Participants were 27 female college students with dysphoric symptoms. There was a moderate effect of PASS on depressive symptoms. There was also a significant within session increase in positive affect from pre to post session among the PASS group, relative to active control; and a significant decrease in positive affect from pre (baseline) to post (follow-up) treatment among the control group, relative to PASS. Results provide preliminary evidence for the efficacy of the treatment module among young adults with depressed mood, and lay the foundation for future research.

Anticipation of aversive stimuli activates extended amygdala in unipolar depression

According to cognitive theories, negative cognitions including negative attitudes towards the future are key factors associated with depressive disorder. We investigated the neural correlates of anticipation of emotional stimuli in patients with unipolar depression to reveal influences of future thinking on brain activity. We used functional magnetic resonance imaging (fMRI) to study 12 female patients with stable antidepressant medication and 12 healthy women. Subjects were presented with positive, negative and neutral pictures that were announced by a congruent cue. Subjects were instructed to expect and subsequently watch the pictures. After scanning, subjects filled the Emotion Regulation Questionnaire (ERQ) to assess the regulation strategies suppression and reappraisal. Compared to the healthy control group, during expectation of negative vs. neutral or positive stimuli the patients showed significantly more activation within the sublenticular extended dorsal amygdala (SLEA) bilaterally but did not differ from controls upon expecting positive stimuli. Hamilton depression scores of the patients correlated positively with activation of the left and right ventral amygdala during expectation of negative stimuli. Furthermore, we found a negative correlation of ventral amygdala activation in the patients with reappraisal scores comprising the ability to limit emotional responding by re-interpreting emotion-eliciting situations. We interpret enhanced activation in the amygdala/SLEA as a possible consequence of altered future thinking in patients suffering from depression. Supporting cognitive theories, this finding does represent evidence that altered cognitions as potentially involved in expectation result in differences in brain activity.