Attention to Emotional Images in Previously Depressed Individuals: An Eye-Tracking Study

Attentional Bias in Older Adults with Non-Clinical Depression: An Eye-Tracking Study

BACKGROUND

Cognitive models of depression assert that attentional biases play an important role in the maintenance of depression. However, few studies have explored attentional bias in depressed older adults, and no consistent conclusions have been reached.

METHODS

In the current study, we investigated attentional bias in older adults with non-clinical depression. Older adults aged over 60 with non-clinical depression and without depression were instructed to perform a free viewing task while their eye movements were tracked.

RESULTS

The results showed that, compared to older adults without depression, non-clinically depressed older adults had longer total fixation durations and a greater number of fixations on sad stimuli. Moreover, non-depressed older adults exhibited a preference for pleasant images, whereas this effect was not observed in older adults with non-clinical depression.

CONCLUSION

This study suggested that non-clinically depressed older adults have attentional bias, which is manifested as increased attention to sad stimuli and decreased attention to pleasant stimuli.The current study has functional and potential functional implications.

Attentional bias for rejection and sad words in Chinese left-behind children with depression

BACKGROUND

This study aimed to examine attentional bias (AB) for sad and social rejection words in Chinese left-behind children (LBC) with depression.

METHOD

We investigated both stimulus specificity and components of AB in different groups using a cross-sectional design. Data were drawn from a school assessment of depression and anxiety, from which we selected LBC with depression (n = 40), LBC without depression (n = 33), a control group with depression (n = 31), and a control group without depression (n = 37). AB was measured with a dot-probe task covering two stimulus types (sad and rejection).

RESULTS

The analysis of AB scores revealed a significant three-way interaction (LBC × depression × word type), F(1, 137) = 4.00, p = 0.047, η2 = 0.028, with depressed non-LBC exhibiting a significant depression × word type interaction, F(1, 66) = 4.67, p = 0.034, η2 = 0.066, while the depression × word type interaction was not significant in LBC, F(1, 71) = 0.18, p = 0.675, η2 = 0.002. Depressed children living with their parents showed AB towards sad words but not rejection words, while depressed LBC showed greater AB towards both rejection and sad words.

CONCLUSIONS

The findings provide evidence that an AB towards sad information is critically involved in the depressed LBC. Compared with non-LBC depressed individuals, an AB for rejection may be involved as a risk factor in the LBC. It sheds light on the effective intervention programmes for LBC's depression and have important practical significance for reducing depression and improving the mental health of LBC.

Emotional Bias among Individuals at Risk for Seasonal Affective Disorder-An EEG Study during Remission in Summer

Emotional bias in attention and memory is well researched in depression. Patients with depression prioritize processing of negative information over positive input. While there is evidence that emotional bias exists in seasonal affective disorder (SAD) during winter, it is unclear whether such altered cognition exists also during summer. Moreover, it is unclear whether such bias affects attention, memory, or both. In this study, we investigated 110 individuals in summer, 34 of whom reported suffering from low mood during winter, according to the seasonal pattern assessment questionnaire. While the electroencephalogram was recorded, participants learned 60 emotional pictures and subsequently were asked to recognize them in an old/new task. There were no clear group differences in behavioral measures, and no brain response differences in frontal alpha power during learning. During recognition, at 100-300 ms post stimulus individuals with higher seasonality scores exhibited larger alpha power in response to negative as compared to neutral stimuli, while individuals with low seasonality scores exhibited larger alpha power in response to positive as compared to neutral stimuli. While we cannot draw conclusions whether this is an effect of attention or memory, the finding suggests that early cognitive processes are altered already during summer in individuals with increased likelihood to experience SAD during winter. Our data provide evidence for an all-year-round cognitive vulnerability in this population.

Application of attentional bias modification to reduce attentional bias and emotional reactivity to stress in mildly depressed individuals

This study aims to verify the effectiveness of attentional bias modification (ABM) in reducing attentional bias related to depression, particularly in the later stages of attention as a pattern of difficulty in disengagement from depression-relevant stimuli, and to assess its effects on emotional reactivity to stress. A total of 78 participants were separated into four groups based on their levels of depression (minimal and mild) and the types of ABM. The positive ABM (pABM) trained participants to disengage their attention from depression-relevant stimuli and directed their attention toward more positive stimuli, whereas the neutral ABM (nABM) was designed to have no effect. The participants underwent a free-viewing task by eye tracker both before and after ABM to observe changes in attentional bias. Subsequently, they reported their emotional response after a stress-inducing task. The group of mildly depressed participants receiving pABM showed significantly less attention to depression-relevant negative affective stimuli and reported significantly decreased negative emotional reactivity to stress compared to the other groups. pABM had an effect on decreasing difficulty in disengaging from depression-relevant negative affective words (DW). However, it did not increase the dwell time on positive affective words (PW) in the current study. This might be due to the short duration of the application of ABM. The current study conducted ABM twice in 1 day, and this might not be enough to increase the dwell time on PA. This study verified that the ABM effectively decreased the attentional bias of depression and its relevant symptom, emotional reactivity to stress.

Modeling brain dynamics and gaze behavior: Starting point bias and drift rate relate to frontal midline theta oscillations

Frontal midline theta oscillatory dynamics have been implicated as an important neural signature of inhibitory control. However, most proactive cognitive control studies rely on behavioral tasks where individual differences are inferred through button presses. We applied computational modeling to further refine our understanding of theta dynamics in a cued anti-saccade task with gaze-contingent eye tracking. Using a drift diffusion model, increased frontal midline theta power during high-conflict, relative to low-conflict, trials predicted a more conservative style of responding through the starting point (bias). During both high- and low-conflict trials, increases in frontal midline theta also predicted improvements in response efficiency (drift rate). Regression analyses provided support for the importance of the starting point bias, which was associated with frontal midline theta over the course of the task above-and-beyond both drift rate and mean reaction time. Our findings provide a more thorough understanding of proactive gaze control by linking trial-by-trial increases of frontal midline theta to a shift in starting point bias facilitating a more neutral style of responding.

Rethinking the risk for depression using the RDoC: A psychophysiological perspective

Considering that the classical categorical approach to mental disorders does not allow a clear identification of at-risk conditions, the dimensional approach provided by the Research Domain Criteria (RDoC) is useful in the exploration of vulnerability to psychopathology. In the RDoC era, psychophysiological models have an important role in the reconceptualization of mental disorders. Indeed, progress in the study of depression vulnerability has increasingly been informed by psychophysiological models. By adopting an RDoC lens, this narrative review focuses on how psychophysiological models can be used to advance our knowledge of the pathophysiological mechanisms underlying depression vulnerability. Findings from psychophysiological research that explored multiple RDoC domains in populations at-risk for depression are reviewed and discussed. Future directions for the application of psychophysiological research in reaching a more complete understanding of depression vulnerability and, ultimately, improving clinical utility, are presented.

Emotional stimulation processing characteristics in depression: Meta-analysis of eye tracking findings

Objective

To systematically evaluate the attentional bias in patients with depression toward emotional stimuli and to explore eye movement indicators and potential regulatory variables that can distinguish such patients from healthy individuals.

Methods

Case-control studies regarding eye-tracking in major depressive disorder published in PubMed, Web of Science, ScienceDirect, The Cochrane Library, EBSCOhost, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases from database initiation until March 12, 2022 were included in the present meta-analysis. Two researchers independently screened the literature and performed data extraction. The quality of the literature was assessed using the Newcastle-Ottawa quality assessment scale.RevMan 5.4 software was used for Meta-analysis.

Results

Overall, 14 studies were included, including 1,167 participants (N _depression = 474; N _healthy = 693). We found that (1) fixation duration was significantly lower for positive emotional stimuli in the depression group than that in the healthy group; however, for negative stimuli, the fixation duration was significantly more in the depression group than in the healthy group. No significant difference was observed in terms of neutral emotional stimuli between groups. (2) Patients with depression exhibited a significantly lower fixation count for positive emotional stimuli than healthy individuals, whereas the fixation count for negative emotional stimuli was significantly higher in the depression group than in the healthy group. No significant difference was found for neutral emotional stimuli between groups. (3) No significant difference was detected in terms of the first fixation duration of the positive, negative, and neutral emotional stimuli between groups. (4) subgroup analysis indicated that age effected fixation duration for positive emotional stimuli. In addition, age and the type of negative emotional picture (sad, dysphoric, threat, anger) effected fixation duration for negative emotional stimuli.

Conclusion

Our research supports that patients with depression exhibit a negative attention bias toward emotional stimuli, and the fixation duration and fixation counts may be used as auxiliary objective indicators for depression screening.

Coherence of attention and memory biases in currently and previously depressed women

Previous research has found that depression is characterised by biased processing of emotional information. Although most studies have examined cognitive biases in isolation, simultaneous examination of multiple biases is required to understand how they may interact and influence one another to produce depression vulnerability. In this study, the attention and memory biases of currently depressed, previously depressed, and never depressed women were examined using the same stimuli and a unified methodology. Participants viewed negative, positive, and neutral words while their eye gaze was tracked and recorded. After a distraction task, participants completed an incidental recognition test that included words from the eye-tracking task and new words. The results supported the hypothesised mediation model for positive words: currently depressed women had a reduced attention bias for positive words and, in turn, had poorer memory for positive words relative to never depressed women. Previously depressed women, however, showed a lack of coherence between attention and memory biases for positive words. The groups did not differ in their attention or memory biases for negative words. The findings provide novel evidence in support of a causal link between the absence of protective attention and memory biases for positive information in clinical depression.

An Eye-Tracking Study of Attention Biases in Children at High Familial Risk for Depression and Their Parents with Depression

Attention biases (AB) are a core component of cognitive models of depression yet it is unclear what role they play in the transgenerational transmission of depression. 44 children (9-14 years) with a high familial risk of depression (HR) were compared on multiple measures of AB with 36 children with a low familial risk of depression (LR). Their parents: 44 adults with a history of depression (HD) and 36 adults with no history of psychiatric disorder (ND) were also compared. There was no evidence of group differences in AB; neither between the HR and LR children, nor between HD and ND parents. There was no evidence of a correlation between parent and child AB. The internal consistency of the tasks varied greatly. The Dot-Probe Task showed unacceptable reliability whereas the behavioral index of the Visual-Search Task and an eye-tracking index of the Passive-Viewing Task showed better reliability. There was little correlation between the AB tasks and the tasks showed minimal convergence with symptoms of depression or anxiety. The null-findings of the current study contradict our expectations and much of the previous literature. They may be due to the poor psychometric properties associated with some of the AB indices, the unreliability of AB in general, or the relatively modest sample size. The poor reliability of the tasks in our sample suggest caution should be taken when interpreting the positive findings of previous studies which have used similar methods and populations.

Attentional bias towards interpersonal aggression in depression - an eye movement study

Depressed individuals exhibit an attentional bias towards mood-congruent stimuli, yet evidence for biased processing of threat-related information in human interaction remains scarce. Here, we tested whether an attentional bias towards interpersonally aggressive pictures over interpersonally neutral pictures could be observed to a greater extent in depressed participants than in control participants. Eye movements were recorded while the participants freely viewed visually matched interpersonally aggressive and neutral pictures, which were presented in pairs. Across the groups, participants spent more time looking at neutral pictures than at aggressive pictures, probably reflecting avoidance behavior. When the participants could anticipate the stimulus valence, depressed participants - but not controls - showed an early attentional bias towards interpersonally aggressive pictures, as indexed by their longer first fixation durations on aggressive pictures than on neutral pictures. Our results thus preliminarily suggest both an early attentional bias towards interpersonal aggression, which is present, in depressed participants, also when aggression contents are anticipated, and a later attentional avoidance of aggression. The early depression-related bias in information processing may have maladaptive effects on the way depressed individuals perceive and function in social interaction and can, therefore, maintain depressed mood.

Is a Negative Attentional Bias in Individuals with Autism Spectrum Disorder Explained by Comorbid Depression? An Eye-Tracking Study

Heightened attention towards negative information is characteristic of depression. Evidence is emerging for a negative attentional bias in Autism spectrum disorder (ASD), perhaps driven by the high comorbidity between ASD and depression. We investigated whether ASD is characterised by a negative attentional bias and whether this can be explained by comorbid (sub) clinical depression. Participants (n = 116) with current (CD) or remitted depression (RD) and/or ASD, and 64 controls viewed positively and negatively valenced (non-)social pictures. Groups were compared on three components of visual attention using linear mixed models. Both CD individuals with and without ASD, but not remitted depressed and never-depressed ASD individuals showed a negative bias, suggesting that negative attentional bias might be a depressive state-specific marker for depression in ASD.

Mind your gaze: Examining the relation between trait mindfulness and visual attention to valenced images

Trait mindfulness pertains to one's ability to non-judgmentally attend to experiences. While attention regulation represents a core component of mindfulness, the relation between trait mindfulness and visual attention is unclear. Further, despite established associations between mindfulness and emotion regulation, few studies have examined whether trait mindfulness may be related to attention to emotionally valenced content. Thus, the present study used an eye-tracking paradigm to assess relations between trait mindfulness, emotion regulation and selective visual attention to valenced stimuli. Participants (N = 123; 75.6 % female; 87 % Caucasian; M_age = 19.14 years) completed measures of trait mindfulness, emotion regulation, and engaged in an eye-tracking paradigm in which they viewed sad, threatening, neutral, and happy images simultaneously. Dwell times on images (all categories combined), black space on screen, and each image category were calculated. Bivariate correlations were assessed to determine the relations among mindfulness, emotion regulation, and visual attention, controlling for mood. Trait mindfulness was associated with longer dwell time on images overall, but specifically longer dwell time on threatening and happy images. Although trait mindfulness and emotion regulation were positively associated, emotion regulation was not significantly associated with visual attention. These results suggest that trait mindfulness is associated with visual attention to valenced stimuli, particularly happy and threatening images, and emotion regulation does not account for these relations. These findings add to our understanding of the cognitive mechanisms underlying trait mindfulness.

Chinese college students' ability to recognize facial expressions based on their meaning-in-life profiles: An eye-tracking study

OBJECTIVE

People can be categorized into one of four meaning-in-life profiles: High Presence High Search (HPHS), High Presence Low Search (HPLS), Low Presence High Search (LPHS), and Low Presence Low Search (LPLS).The main goal of this study is to provide a theoretical explanation for why Chinese people with different meaning-in-life profiles have different mental health levels than Western people, based on their emotional-cognitive-processing ability.

METHOD

We adopted eye-movement analysis and recognition-judgment experimental paradigm concerning absolute-recognition judgment and relative-recognition judgment in our study. Moreover, we applied a multifactor and multilevel mixed-experimental design. We selected 118 participants for the experiments from the 788 Chinese college students who responded.

RESULTS

Our results showed that HPHS individuals preferred positive-emotion pictures, LPLS individuals preferred negative-emotion pictures, HPLS individuals preferred positive- and neutral-emotion pictures, and LPHS individuals preferred neutral-emotion pictures. Moreover, HPHS individuals were better at accurately processing facial expression from pictures, while LPLS individuals lacked such ability. The fine-processing ability of HPLS and LPHS individuals was lower than that of HPHS yet higher than that of LPLS individuals. Moreover, the features of HPLS individuals were closer to HPHS, while those of LPHS individuals were closer to LPLS.

CONCLUSIONS

Our findings support the hypothesis that meaning-in-life profiles have different immediate processing abilities and preferences regarding facial expression recognition and different emotional-cognitive-processing ability.

Attentional biases to emotional information in clinical depression: A systematic and meta-analytic review of eye tracking findings

BACKGROUND

In the last decade, eye-tracking technology has been increasingly used to investigate attention orientation in depression. The aim of the current review was to summarize the available eye-tracking research specifying the effects of clinical depression on early and late attention allocation during visual perception of emotional material.

METHODS

The literature search identified sixteen relevant publications, including twelve free-viewing studies in which multiple stimulus arrays with images (scenarios) or faces were administered. Meta-analyses were conducted to evaluate the impact of acute depression on attentional maintenance during free viewing as a function of type and emotional quality of stimulus material.

RESULTS

Moderate (to large) differences were observed between depressed and healthy individuals in maintained attention to dysphoric images (Hedges' g = .66) and sad faces (g = .58). Moderate group differences were also revealed for maintained attention to positive images (g = -.51) and happy faces (g = -.54). Age of patients explained between study variance in effect sizes for attention to happy faces. No group differences in initial attention orientation were found.

LIMITATIONS

The number of free-viewing studies based on images was low (n=4).

CONCLUSIONS

Our results suggest that clinical depression is characterized by medium-sized increases of attention maintenance for dysphoric and medium-sized decreases for positive stimuli compared to healthy individuals. Therefore, both alterations represent equally important targets for attention modification programs. Depressed patients seem not to manifest abnormalities in early orienting to emotional stimuli. Differences between patients and healthy subjects in attention to positive stimuli may diminish with age.

The relationship between dispositional attention to feelings and visual attention to emotion

Attention to feelings is a core dimension of individual differences in the perception of one's emotions. It concerns the frequency with which own emotions are attended to. The aim of the present eye-tracking investigation was to examine the relationship of dispositional attention to feelings with early and late attentional processes in the visual perception of emotional information. Attentional orientation was assessed in a sample of healthy women (N = 91) using eye-tracking during a free viewing task in which images with positive, negative and neutral content were shown simultaneously. Pictures were taken from the Besançon Affective Picture Set. State and trait affect, depression, and intelligence of participants were controlled. In our sample, attention to feelings was not related to positive affect, negative affect, depression or intelligence. Attention to feelings was negatively correlated with entry times for all emotional picture types. Moreover, attention to feelings was positively correlated with dwell time on positive images and negatively correlated with dwell time on neutral images. Our data indicate that devoting habitually attention to one's feelings is linked to an enhanced initial orientation of attention towards emotional scenes, irrespective of affective valence. Dispositional attention to feelings might also be associated with an attentional preference for emotional over neutral visual stimuli. The present findings on general individual differences in attention to feelings could have important implications for future clinical research on attentional biases.

Face perception without subjective awareness - Emotional expressions guide early gaze behavior in clinically depressed and healthy individuals

BACKGROUND

Major depressive disorder is associated with attentional biases in the explicit processing of emotional facial expressions. It is unclear if attentional biases for emotional faces also exist at an automatic level of perception.

METHOD

Gaze behavior of twenty-nine clinically depressed individuals and twenty-nine gender matched healthy controls was compared in an affective priming task. Happy, neutral, sad, angry, and fearful facial expressions were presented very briefly as primes with forward and backward masking, followed by a neutral expression. Participants' early gaze behavior on neutral faces was analyzed for the eyes and mouth as areas of interest. Only participants who were subjectively unaware of the emotional prime faces were included in the analyses.

RESULTS

Masked emotional facial expressions elicited early eye movements toward diagnostic features of the face. Both, depressed patients and healthy controls oriented their initial fixation on the face more often to the eye region after the presentation of fearful or sad compared to happy primes. However, depressed patients oriented their gaze generally far less to the eye and mouth region compared to healthy controls.

LIMITATION

Awareness of emotional prime faces was assessed by a systematic interview but not by an objective detection task.

CONCLUSION

Our data suggest enhanced attentional orienting toward the eye region due to fearful and sad faces in depressed and healthy individuals. In spite of this early expression-specific vigilance, depressed individuals oriented their gaze overall less to the eyes and mouth compared to healthy controls, which might represent an avoidance of facial features.

Instructed Partnership Appreciation in Depression: Effects on Mood, Momentary Relationship Satisfaction, and Psychobiological Arousal

BACKGROUND

Depressive disorders are associated with attentional bias and social anhedonia. There is evidence supporting the hypothesis that depressed individuals participate less in potentially rewarding social situations and exhibit alterations in stress reactivity. With the present study, we aimed at investigating the affective and psychobiological response of couples with a depressed (female) partner in an instructed partnership appreciation task (PAT) that included positive and appreciative communication.

METHODS

In a quasi-experimental repeated-measures design, depressive couples (DCs)-i.e., the female partner being diagnosed with a depressive disorder-were compared to non-depressive couples (NDCs). Study outcomes were the PAT-induced changes in state mood, momentary relationship satisfaction, salivary cortisol, and salivary alpha-amylase. Additionally, we assessed psychometric baseline data on depression, relationship quality, social support, and chronic stress. Data was analyzed using multilevel modeling.

RESULTS

A total of 184 individuals from N = 47 DCs and N = 45 NDCs were included. DCs were characterized by higher depressiveness, lower relationship quality, less actually received social support from the partner, and higher chronic stress than NDCs. Manipulation checks led to the additional exclusion of two couples. Regarding mood, depressed women showed lower baseline scores and no significant differences in mood increase compared to non-depressed women (p = 0.107). Increases in relationship satisfaction were significantly stronger in the depressed group (p = 0.035). In addition, we found a significantly stronger cortisol increase in depressed women, but only if relationship duration was taken into account as a moderating factor (p = 0.022). No significant group differences were found for women's amylase trajectories or for sex-dependent interaction effects on the couple level (all p > 0.05).

CONCLUSIONS

Instructed engagement in positive couple interaction may require high effort and increased psychobiological arousal, but may finally result in emotional and social benefits in depressed women. While these findings encourage speculations about the therapeutic application of instructed partnership appreciation, more research is needed on the effectiveness of such interventions and on the moderating role of relationship duration in depression and couple functioning.

Emotional Expression Processing and Depressive Symptomatology: Eye-Tracking Reveals Differential Importance of Lower and Middle Facial Areas of Interest

The current study explored the eye-tracking patterns of individuals with nonclinical levels of depressive symptomatology when processing emotional expressions. Fifty-three college undergraduates were asked to label 80 facial expressions of five emotions (anger, fear, happiness, neutral, and sadness) while an eye-tracker measured visit duration. We argue visit duration provides more detailed information for evaluating which features of the face are used more often for processing emotional faces. Our findings indicated individuals with nonclinical levels of depressive symptomatology process emotional expressions very similarly to individuals with little to no depressive symptoms, with one noteworthy exception. In general, individuals in our study visited the "T" region, lower and middle AOIs (Area of Interest), more often than upper and noncore areas, but the distinction between the lower and middle AOIs appears for happiness only when individuals are higher in depressive symptoms.

Attentional biases in dysphoria when happy and sad faces are simultaneously presented

BACKGROUND AND OBJECTIVE

Difficulties to engage attention to positive stimuli and to disengage attention from negative stimuli are typically found in depression. Yet, most of the evidence supporting these attentional biases comes from experimental paradigms in which emotional information (e.g., happy or sad faces) is simultaneously presented with neutral information. Few studies have explored attentional biases when emotional stimuli of different valence are presented simultaneously. The aim of the present study was to assess visual scan patterns of non-dysphoric and dysphoric participants when emotional information is presented simultaneously.

METHOD

Using an eye-tracker methodology, the gradient relation between attentional biases and depression scores as well as differences between groups in their attentional performance were assessed in non-dysphoric participants (N = 84) and dysphoric participants (N = 58). Three different pairs of faces were used: happy-neutral, neutral-sad, and happy-sad.

RESULTS

First, we found that simultaneous presentation of emotional information (i.e., happy vs. negative faces) reduces the magnitude of attentional biases towards positive information. Second, we also found a significant negative relation between attentional biases towards positive information and depression scores. Finally, compared to non-dysphoric participants, dysphoric individuals marginally spent less time attending positive information in both happy-neutral and happy-sad trials.

LIMITATIONS

The cross-sectional nature of our study does not allow us to make inferences about causality. Further, only one type of simultaneous emotional faces presentation (i.e., happy-sad) was used.

CONCLUSIONS

These results support the need for further research on the processing of competing emotional stimuli in depression.

Attentional Control as a Predictor of Response to Psychological Treatment for Depression and Relapse up to 1 year After Treatment: A Pilot Cohort Study

BACKGROUND

Identifying depressed patients unlikely to reach remission and those likely to relapse after reaching remission is of great importance, but there are few pre-treatment factors that can help clinicians predict prognosis and together these explain relatively little variance in treatment outcomes. Attentional control has shown promise in studies to date, but has not been investigated prospectively in routine clinical settings with depressed patients.

AIMS

This study aimed to pilot the use of a brief self-report measure of attentional control in routine care and investigate the associations between attentional control, psychological treatment response and relapse to depression up to 1 year post-treatment.

METHOD

Depressed patients were recruited from two primary care psychological treatment (IAPT) services and completed the Attentional Control Scale (ACS) alongside routine symptom measures at every therapy session. Participants were tracked and followed up for 1 year post-treatment.

RESULTS

Baseline ACS scores were associated with remission and residual depressive symptoms post-treatment, and relapse within 12 months of ending treatment, all independent of pre-treatment depressive symptom severity, and the latter also independent of residual symptoms.

CONCLUSION

A self-report measure of attentional control can potentially be used to predict levels of depressive symptoms post-treatment and can contribute to predicting risk of relapse to depression in IAPT services, without affecting rates of therapy completion/drop-out or data completion of standard IAPT measures. However, this pilot study had a small overall sample size and a very small number of observed relapses, so replication in a larger study is needed before firm conclusions can be made.

Looking for the negative: Depressive symptoms in adolescent girls are associated with sustained attention to a potentially critical judge during in vivo social evaluation

Attention biases toward negative stimuli are implicated in the development and maintenance of depression. However, research is needed to understand how depression affects attention biases as they unfold in a dynamic social environment, particularly during adolescence when depression rates significantly increase due to enhanced reactivity to social stress. To examine attention biases in a live, socially evaluative environment, 26 adolescent girls from the community gave a speech in front of a potentially critical judge and a positive judge while wearing mobile eye tracking glasses. Girls' depressive symptoms were measured using the Moods and Feelings Questionnaire. Across the sample, girls looked at the positive judge more frequently and for longer periods of time compared with the potentially critical judge. In contrast, higher depressive symptoms were associated with looking at the potentially critical judge for longer periods of time. When directly comparing attention to the potentially critical judge relative to the positive judge, dysphoric girls looked at the potentially critical judge more frequently and for longer periods of time compared with the positive judge. Findings suggest that adolescent depressive symptoms are related to sustained attention toward potentially critical evaluation at the exclusion of positive evaluation. This novel approach allowed for an in vivo examination of attention biases as they unfold during social evaluation, which begins to illuminate the interpersonal significance of attention biases. If replicated and extended longitudinally, this research could be used to identify adolescents at high risk for future depression and potentially be leveraged clinically in attention bias modification treatment.

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.

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.

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.

Enhancing Social Interaction in Depression (SIDE study): protocol of a randomised controlled trial on the effects of a Cognitively Based Compassion Training (CBCT) for couples

INTRODUCTION

Positive social interactions (PSIs) and stable relationships can exert substantial benefits on health. However, patients suffering from depression benefit less from these health-promoting effects. Moreover, relationship quality and even partners' health has been found to be negatively affected by depressive symptomatology, which may result in overall impairments in social functioning of a romantic couple. Psychobiological research indicates that these impairments may be accompanied by a maladaptive regulation of the patient's neuroendocrine response to external stressors. Concerning the improvement of social functioning, first studies showed promising results of "Cognitively Based Compassion Training (CBCT®)". However, randomised trials are still scarce. Previous programmes did not involve participation of the patient's romantic partner. Therefore, the present study aims to investigate whether a CBCT® programme adapted for couples (CBCT®-fC) can improve depressive symptoms, distress, social interaction skills and the neurobiological regulation of stress.

METHODS AND ANALYSIS

Couples with the female partner suffering from depression will be invited to participate in a pre-to-post intervention assessment on two consecutive days, respectively, involving a standardised PSI task, eye-tracking, ECG recordings, saliva-sampling, blood-sampling and questionnaire data. After baseline assessment, participating couples will be randomised to either a 10 week CBCT®-fC or to a treatment as usual control condition. The primary endpoint is the reduction of depressive symptoms measured by the Hamilton Depression Rating Scale. Secondary outcomes encompass self-rated depression (Beck Depression Inventory), attention towards the partners face during PSI (eye tracking), stress-related biomarkers (cortisol, α-amylase, interleukin (IL)-1ß/IL-6, heart rate variability), methylation of oxytocin-receptor-genes and serotonin-transporter-genes and self-ratings of psychological constructs such as relationship quality and empathy.

ETHICS AND DISSEMINATION

Ethical approval has been obtained by the Ethics Committee of the Medical Faculty Heidelberg. Results will be presented in international, peer-reviewed journals and on conferences in the field of clinical psychology and psychiatry.

TRIAL REGISTRATION NUMBER

NCT03080025.

Cognitive performance in antidepressant-free recurrent major depressive disorder

BACKGROUND

Cognitive complaints are common in depression, and cognition may be an important treatment target as cognitive problems often remain during remission and may contribute to recurrence risk. Previous studies of cognitive performance in depression have mainly examined late-life depression, with a focus on older adults, or assessed performance in specific cognitive tasks rather than cognitive domains.

METHODS

This study examined cognitive performance across multiple cognitive domains in antidepressant-free depressed adults with early onset recurrent depression compared to never-depressed controls. Domain scores were calculated for episodic memory, executive function, processing speed, and working memory, and the effect of depression diagnosis, depression severity, and depression duration on each domain score was examined, including interactions with age, sex, and education.

RESULTS

Currently depressed adults (n = 91) exhibited poorer performance in the processing speed domain compared with never-depressed adults (n = 105). Additionally, there was an interactive effect of depression duration and age on processing speed and executive function domain performance, such that performance was worse with older age and longer duration of depression. There were no effects of depression severity on performance across the cognitive domains.

CONCLUSIONS

These findings support that processing speed deficits appear in young adults with early onset depression that may not be related to current mood. Additionally, the effects of cumulative depressive episodes may interact with aging such that cognitive performance deficits worsen with recurrence over the lifespan.

Implicit negative affect predicts attention to sad faces beyond self-reported depressive symptoms in healthy individuals: An eye-tracking study

Cognitive theories of depression assume biased attention towards mood-congruent information as a central vulnerability and maintaining factor. Among other symptoms, depression is characterized by excessive negative affect (NA). Yet, little is known about the impact of naturally occurring NA on the allocation of attention to emotional information. The study investigates how implicit and explicit NA as well as self-reported depressive symptoms predict attentional biases in a sample of healthy individuals (N = 104). Attentional biases were assessed using eye-tracking during a free viewing task in which images of sad, angry, happy and neutral faces were shown simultaneously. Participants' implicit affectivity was measured indirectly using the Implicit Positive and Negative Affect Test. Questionnaires were administered to assess actual and habitual explicit NA and presence of depressive symptoms. Higher levels of depressive symptoms were associated with sustained attention to sad faces and reduced attention to happy faces. Implicit but not explicit NA significantly predicted gaze behavior towards sad faces independently from depressive symptoms. The present study supports the idea that naturally occurring implicit NA is associated with attention allocation to dysphoric facial expression. The findings demonstrate the utility of implicit affectivity measures in studying individual differences in depression-relevant attentional biases and cognitive vulnerability.

Emerging applications of eye-tracking technology in dermatology

Eye-tracking technology has been used within a multitude of disciplines to provide data linking eye movements to visual processing of various stimuli (i.e., x-rays, situational positioning, printed information, and warnings). Despite the benefits provided by eye-tracking in allowing for the identification and quantification of visual attention, the discipline of dermatology has yet to see broad application of the technology. Notwithstanding dermatologists' heavy reliance upon visual patterns and cues to discriminate between benign and atypical nevi, literature that applies eye-tracking to the study of dermatology is sparse; and literature specific to patient-initiated behaviors, such as skin self-examination (SSE), is largely non-existent. The current article provides a review of eye-tracking research in various medical fields, culminating in a discussion of current applications and advantages of eye-tracking for dermatology research.

Differences in emotional stimuli processing in subjects with MTLE with and without depression

In healthy people, a preference in attention maintenance and memory for words with emotional valence comparing to neutral words has been shown. The pattern of emotional stimuli processing may be different in people with mesial temporal lobe epilepsy (MTLE) and it may be sensitive to the presence of depressive symptoms. In order to explore these possibilities, we applied the emotional spatial cueing attentional task and the free recall memory task to participants (N=39) with MTLE and compared them with healthy controls. We hypothesized that the pattern of maintaining attention and remembering emotional words is different in people with MTLE. Current literature indicates that this pattern will change from positive bias in the controls, though no emotional bias in the participants with MTLE without depression (MTLE-d), and in this work we examined this pattern in the participants with MTLE with depressive symptoms (MTLE+d). Our results show that in both attention and memory, control subjects exhibit positive emotional bias, the subjects with MTLE-d show nonemotional bias and the subjects with MTLE+d have bias away from positive words. Participants with MTLE+d maintained attention for positive words shorter than others. Participants with MTLE+d had worse recall for positive words than the participants with MTLE-d and for all words when compared to controls. We found that faster attention disengagement from positive words and worse memory for positive words is associated with elevated levels of depressive symptoms.

Deadly Attraction - Attentional Bias toward Preferred Cigarette Brand in Smokers

Numerous studies have shown that biases in visual attention might be evoked by affective and personally relevant stimuli, for example addiction-related objects. Despite the fact that addiction is often linked to specific products and systematic purchase behaviors, no studies focused directly on the existence of bias evoked by brands. Smokers are characterized by high levels of brand loyalty and everyday contact with cigarette packaging. Using the incentive-salience mechanism as a theoretical framework, we hypothesized that this group might exhibit a bias toward the preferred cigarette brand. In our study, a group of smokers (N = 40) performed a dot probe task while their eye movements were recorded. In every trial a pair of pictures was presented - each of them showed a single cigarette pack. The visual properties of stimuli were carefully controlled, so branding information was the key factor affecting subjects' reactions. For each participant, we compared gaze behavior related to the preferred vs. other brands. The analyses revealed no attentional bias in the early, orienting phase of the stimulus processing and strong differences in maintenance and disengagement. Participants spent more time looking at the preferred cigarettes and saccades starting at the preferred brand location had longer latencies. In sum, our data shows that attentional bias toward brands might be found in situations not involving choice or decision making. These results provide important insights into the mechanisms of formation and maintenance of attentional biases to stimuli of personal relevance and might serve as a first step toward developing new attitude measurement techniques.

Attentional bias scores in patients with depression and effects of age: a controlled, eye-tracking study

Objective

To compare the attentional bias of depressed patients and non-depressed control subjects and examine the effects of age using eye-tracking technology in a free-viewing set of tasks.

Methods

Patients with major depressive disorder (MDD) and non-depressed control subjects completed an eye-tracking task to assess attention of processing negative, positive and neutral facial expressions. In this cross-sectional study, the tasks were separated in two types (neutral versus happy faces and neutral versus sad faces) and assessed in two age groups (‘young’ [18–30 years] and ‘middle-aged’ [31–55 years]).

Results

Compared with non-depressed control subjects (n = 75), patients with MDD (n = 90) had a significant reduced positive attentional bias and enhanced negative attentional bias irrespective of age. The positive attentional bias in ‘middle-aged’ patients with MDD was significantly lower than in ‘young’ patients, although there was no difference between the two age groups in negative attentional bias.

Conclusions

These results confirm that there are emotional attentional biases in patients with MDD and that positive attentional biases are influenced by age.

Deployment of attention to emotional pictures varies as a function of externally-oriented thinking: An eye tracking investigation

BACKGROUND AND OBJECTIVES

Alexithymia is a multidimensional personality construct including the components difficulties identifying feelings (DIF), difficulties describing feelings (DDF), and externally oriented thinking (EOT). Different features of alexithymia are thought to reflect specific deficits in the cognitive processing and regulation of emotions. The aim of the present study was to examine for the first time patterns of deployment of attention as a function of alexithymia components in healthy persons by using eye-tracking technology. It was assumed that EOT is linked to avoidance of negative images.

METHODS

99 healthy adults viewed freely pictures consisting of anxiety-related, depression-related, positive, and neutral images while gaze behavior was registered. Alexithymia was assessed by the 20-Item Toronto Alexithymia Scale. Measures of anxiety, depression, and (visual-perceptual) intelligence were also administered.

RESULTS

A main effect of emotion condition on dwell times was observed. Viewing time was lowest for neutral images, longer for depression-related and happy images, and longest for anxiety-related images. Gender and EOT had significant effects on dwell times. EOT correlated negatively with dwell time on depression-related (but not anxiety-related) images. There were no correlations of dwell times with depression, trait anxiety, intelligence, DIF, or DDF.

LIMITATIONS

Alexithymia was assessed exclusively by self-report.

CONCLUSIONS

Our results show that EOT but not DIF or DDF influences attention deployment to simultaneously presented emotional pictures. EOT may reduce attention allocation to dysphoric information. This attentional characteristic of EOT individuals might have mood protecting effects but also detrimental impacts on social relationships and coping competencies.

Attention bias in older women with remitted depression is associated with enhanced amygdala activity and functional connectivity

BACKGROUND

Cognitive bias is a common characteristic of major depressive disorder (MDD) and is posited to remain during remission and contribute to recurrence risk. Attention bias may be related to enhanced amygdala activity or altered amygdala functional connectivity in depression. The current study examined attention bias, brain activity for emotional images, and functional connectivity in post-menopausal women with and without a history of major depression.

METHODS

Attention bias for emotionally valenced images was examined in 33 postmenopausal women with (n=12) and without (n=21) a history of major depression using an emotion dot probe task during fMRI. Group differences in amygdala activity and functional connectivity were assessed using fMRI and examined for correlations to attention performance.

RESULTS

Women with a history of MDD showed greater attentional bias for negative images and greater activity in brain areas including the amygdala for both positive and negative images (pcorr <0.001) than women without a history of MDD. In all participants, amygdala activity for negative images was correlated with attention facilitation for emotional images. Women with a history of MDD had significantly greater functional connectivity between the amygdala and hippocampal complex. In all participants amygdala-hippocampal connectivity was positively correlated with attention facilitation for negative images.

LIMITATIONS

Small sample with unbalanced groups.

CONCLUSIONS

These findings provide evidence for negative attentional bias in euthymic, remitted depressed individuals. Activity and functional connectivity in limbic and attention networks may provide a neurobiological basis for continued cognitive bias in remitted depression.

Competition Effects in Visual Cortex Between Emotional Distractors and a Primary Task in Remitted Depression

BACKGROUND

Attentional biases, particularly difficulty inhibiting attention to negative stimuli, are implicated in risk for major depressive disorder (MDD). The current study examined a neural measure of attentional bias using a continuous index of visuocortical engagement (steady-state visual evoked potentials [SSVEPs]) before and after a negative mood induction in a population at high-risk for MDD recurrence due to a recently remitted MDD (rMDD) episode. Additionally, we examined working memory (WM) capacity as a potential moderator of the link between rMDD and visuocortical responses.

METHODS

Our sample consisted of 27 women with rMDD and 28 never-depressed women. To assess attentional inhibition to emotional stimuli, we measured frequency-tagged SSVEPs evoked from spatially superimposed task-relevant stimuli and emotional distractors (facial displays of emotion) oscillating at distinct frequencies. WM capacity was assessed during a visuospatial memory task.

RESULTS

Women with rMDD, relative to never-depressed women, displayed difficulty inhibiting attention to all emotional distractors before a negative mood induction, with the strongest effect for negative distractors (sad faces). Following the mood induction, rMDD women's attention to emotional distractors remained largely unchanged. Among women with rMDD, lower WM capacity predicted greater difficulty inhibiting attention to negative and neutral distractors.

CONCLUSIONS

By exploiting the phenomenon of oscillatory resonance in the visual cortex, we tracked competition in neural responses for spatially superimposed stimuli differing in valence. Results demonstrated that women with rMDD display impaired attentional inhibition of emotional distractors independent of state mood and that this bias is strongest among those with lower WM capacity.

The Effect of Emotion and Reward Contingencies on Relational Memory in Major Depression: An Eye-Movement Study with Follow-Up

Background: Episodic memory disturbances were found to constitute a potential trait marker for major depression (MD). The recall of positive or rewarding information in a relational context is specifically impaired. Eye-movement recording constitutes a novel, direct approach to examine implicit memory performance. Here we aimed to assess the effect of emotional context and implicit virtual monetary reward or loss on viewing patterns in association with relational memory in a 6-months follow-up study in MD.

Materials and Methods: Twenty-eight patients with MD and 30 healthy participants were trained to associate a face (happy/sad/neutral) with a background scene. After each pair a virtual monetary reward or loss appeared briefly. During testing, scenes were presented as a cue and then overlaid with three previously studied faces. Participants were asked to recall the matching face if present (Match trials), with eye-movements and subsequent forced-choice recognition being recorded.

Results: Explicit recognition of the matching face was impaired in the MD group as compared to controls. In correlation with this, viewing of the matching face was significantly reduced in the MD group. We found a significant interaction of group (MD vs HC) with the relational memory condition (Match and Non-match), facial emotion and monetary reward and loss. MD patients attended longer to previously rewarded stimuli, but significantly less to sad faces in the Match condition. The relational memory impairment persisted at follow-up and correlated with symptom severity both at baseline and follow-up. Viewing patterns associated with previous virtual reward were associated with clinical symptoms at follow-up.

Conclusion: Our current results provide novel evidence for a specific relational memory impairment in MD as supported by abnormal eye-movement behavior and a deficit in explicit recognition. MD patients showed an attentional bias to rewarded stimuli and decreased viewing of sad faces when relational memory information was present.

Alleviated negative rather than positive attentional bias in patients with depression in remission: an eye-tracking study

Objective To investigate attentional bias toward happy and sad faces in remitted depressed (RD) patients compared with healthy control (HC) subjects. Methods This cross-sectional study enrolled RD patients and sex- and age-matched HC subjects. Eye movement data were acquired for all study participants while free viewing a 2 × 2 matrix of emotional faces. The attentional bias toward different emotional faces and whether the attention maintenance components generated attentional bias in the RD patients were analysed by comparing the attentional modes of the RD group with the HC group. Results A total of 27 RD patients and 27 HC subjects were analysed in this study. The RD and HC groups exhibited no significant differences toward first fixation location and initial attentional maintenance. In later attentional maintenance, the RD group showed significantly less attentional bias toward happy faces, but there were no significant differences in their attentional bias toward sad faces, compared with the HC group. Conclusions This present study showed that the negative attentional bias of RD patients was successfully eased, but their positive attentional bias was still insufficient.

Pupillary reactivity to negative stimuli prospectively predicts recurrence of major depressive disorder in women

There is a large body of research supporting the association between disrupted physiological reactivity to negative stimuli and depression. The present study aimed to examine whether physiological reactivity to emotional stimuli, assessed via pupil dilation, served as a biological marker of risk for depression recurrence among individuals who are known to be at a higher risk due to having previous history of depression. Participants were 57 women with a history of major depressive disorder (MDD). Pupil dilation to angry, happy, sad, and neutral faces was recorded. Participants' diagnoses and symptoms were assessed 24 months after the initial assessment. We found that women's pupillary reactivity to negative (sad or angry faces) but not positive stimuli prospectively predicted MDD recurrence. Additionally, we found that both hyper- and hypopupillary reactivity to angry faces predicted risk for MDD recurrence. These findings suggest that disrupted physiological response to negative stimuli indexed via pupillary dilation could serve as a physiological marker of MDD risk, thus presenting clinicians with a convenient and inexpensive method to predict which of the at-risk women are more likely to experience depression recurrence.

Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals

Depression is associated with attentional biases for emotional information that are proposed to reflect stable vulnerability factors for the development and recurrence of depression. A key question for researchers is whether those who have recovered from depression also exhibit attentional biases, and if so, how similar these biases are to those who are currently depressed. To address this question, the present study examined attention to emotional faces in remitted depressed (N=26), currently depressed (N=16), and never depressed (N=33) individuals. Participants viewed sets of four face images (happy, sad, threatening, and neutral) while their eye movements were tracked throughout an 8-s presentation. Like currently depressed participants, remitted depressed participants attended to sad faces significantly more than never depressed participants and attended to happy faces significantly less. Analyzing temporal changes in attention revealed that currently and remitted depressed participants did not reduce their attention to sad faces over the 8-s presentation, unlike never depressed participants. In contrast, remitted depressed participants attended to happy faces similarly to never depressed participants, increasing their attention to happy faces over the 8-s presentation. The implications for cognitive theories of depression and depression vulnerability are discussed.

Eye Movement in Unipolar and Bipolar Depression: A Systematic Review of the Literature

BACKGROUND

The analysis of eye movements (EM) by eye-tracking has been carried out for several decades to investigate mood regulation, emotional information processing, and psychomotor disturbances in depressive disorders.

METHOD

A systematic review of all English language PubMed articles using the terms "saccadic eye movements" OR "eye-tracking" AND "depression" OR "bipolar disorders" was conducted using PRISMA guidelines. The aim of this review was to characterize the specific alterations of EM in unipolar and bipolar depression.

RESULTS

Findings regarding psychomotor disturbance showed an increase in reaction time in prosaccade and antisaccade tasks in both unipolar and bipolar disorders. In both disorders, patients have been reported to have an attraction for negative emotions, especially for negative pictures in unipolar and threatening images in bipolar disorder. However, the pattern could change with aging, elderly unipolar patients disengaging key features of sad and neutral stimuli. METHODological limitations generally include small sample sizes with mixed unipolar and bipolar depressed patients.

CONCLUSION

Eye movement analysis can be used to discriminate patients with depressive disorders from controls, as well as patients with bipolar disorder from patients with unipolar depression. General knowledge concerning psychomotor alterations and affective regulation strategies associated with each disorder can also be gained thanks to the analysis. Future directions for research on eye movement and depression are proposed in this review.

Updating emotional content in recovered depressed individuals: Evaluating deficits in emotion processing following a depressive episode

BACKGROUND AND OBJECTIVES

Previous research has demonstrated that depressed individuals have difficulty both disengaging from negative information and maintaining positive information in working memory (WM). The present study was conducted to examine whether the tendency for depressed individuals to maintain negative content in WM and to experience difficulties maintaining positive content in WM is due to negative mood (in)congruency effects during a depressive episode, or whether these tendencies are evident outside of a depressive episode.

METHODS

Individuals who had recovered from a depressive episode and never disordered controls performed emotion 0-back and 2-back tasks designed to assess biases in updating emotional content in working memory.

RESULTS

Similar to currently depressed individuals in previous studies, recovered depressed participants disengaged from happy stimuli more quickly and from sad stimuli more slowly than did their never-depressed counterparts.

LIMITATIONS

Despite the extension of a depression-specific finding to recovered depressed individuals, the present study does not test whether the identified emotion updating biases predict long-term relapse or recovery.

CONCLUSION

The obtained results suggest that a decreased ability to disengage from negative content and to maintain positive content in WM represents a trait-like cognitive style that impairs adaptive emotion regulation and may contribute to the recurrent nature of depression.

Selective Attention toward Angry Faces and Risk for Major Depressive Disorder in Women: Converging Evidence from Retrospective and Prospective Analyses

The current study examined selective attention toward emotional images as a risk factor for major depressive disorder (MDD). Using multiple indices of attention in a dot-probe task (i.e., reaction time [RT] and eye-tracking-based measures) in a retrospective, high-risk design, we found that women with remitted MDD, compared to controls, exhibited greater selective attention toward angry faces across RT and eye-tracking indices and greater attention toward sad faces for RT measures. Second, we followed women with remitted MDD prospectively to determine if the attentional biases retrospectively associated with MDD history would predict MDD recurrence across a two-year follow-up. We found that women who spent a greater proportion of time looking at angry faces during the dot-probe task at the baseline assessment had a significantly shorter time to MDD onset. Taken together, these findings provide converging retrospective and prospective evidence that selective attention toward angry faces may increase risk for MDD recurrence.