Disentangling the Interplay Among Cognitive Biases: Evidence of Combined Effects of Attention, Interpretation and Autobiographical Memory in Depression

Effects of positive and negative affect inductions on interpretive and response bias

Affective states and interpretations of ambiguous stimuli are inherently related constructs, although effects of induced affective states on interpretive and response biases have not been comprehensively explored. The present study examined the relationship between induced affective states and interpretive and response bias in a sample of 189 undergraduates. Participants completed an online study in which they were randomized into one of two mood induction conditions and subsequently completed an interpretive bias task. Results demonstrated significant condition differences in affect after the mood induction; the positive induction condition demonstrated significantly more positive mood and the negative condition demonstrated more negative mood. A significant difference between conditions emerged with respect to positive interpretive bias for non-social scenarios, with the positive mood induction condition demonstrating more positive interpretive bias to non-social situations than the negative induction condition (p = .04). The negative induction condition demonstrated significantly greater negative response bias for social scenarios (p = .03) and, unexpectedly, a significantly higher positive response bias for non-social scenarios (p = .05). Findings offer some support for the notion that inducing positive affect may promote more positive interpretations of ambiguous scenarios.

Negative interpretation bias as a clinical marker and a scar of depression: New insights from a large-scale study of the scrambled sentence task in formerly, subclinically and clinically depressed individuals

Negative interpretation biases are thought to be clinical markers of depression and risk factors for its recurrence that would remain active after remission. Evidence on the conditions under which negative interpretation biases are active after remission is still unclear, and further studies are required to clarify whether negative interpretation biases are equivalent in magnitude at different depression conditions. A large-scale study of the Scrambled Sentence Task (SST) was conducted (639 participants), where different depression and never-depressed samples were compared in their performance in the SST through three experiments (i.e., formerly - Studies 1 and 2 -, subclinically - Study 2 - and clinically depressed individuals - Study 3 -). Cognitive load manipulations were used while completing the task. Formerly compared to never-depressed individuals showed higher negative interpretation biases at conditions of cognitive load only (Study 1). Formerly and subclinically depressed showed equivalent biases compared to never-depressed individuals (Study 2). Negative interpretation biases were further supported for clinically depressed (Study 3). Comparative analyses showed that both formerly and subclinically differed from clinically depressed individuals in their negative bias magnitude. These results prove the utility of the SST to detect negative interpretation biases in different depression conditions, including those recovered from depression. Results further show that negative bias magnitudes tend to decrease after remission but remain at subclinical levels, potentially conferring risk for depression recurrence.

Microbiota alteration of Chinese young male adults with high-status negative cognitive processing bias

Introduction

Evidence suggests that negative cognitive processing bias (NCPB) is a significant risk factor for depression. The microbiota-gut-brain axis has been proven to be a contributing factor to cognitive health and disease. However, the connection between microbiota and NCPB remains unknown. This study mainly sought to explore the key microbiota involved in NCPB and the possible pathways through which NCPB affects depressive symptoms.

Methods

Data in our studies were collected from 735 Chinese young adults through a cross-sectional survey. Fecal samples were collected from 35 young adults with different levels of NCPB (18 individuals were recruited as the high-status NCPB group, and another 17 individuals were matched as the low-status NCPB group) and 60 with different degrees of depressive symptoms (27 individuals were recruited into the depressive symptom group, as D group, and 33 individuals were matched into the control group, as C group) and analyzed by the 16S ribosomal RNA sequencing technique.

Results

As a result, the level of NCPB correlated with the degree of depressive symptoms as well as anxiety symptoms and sleep quality (p < 0.01). The β-diversity of microbiota in young adults was proven to be significantly different between the high-status NCPB and the low-status NCPB groups. There were several significantly increased bacteria taxa, including Dorea, Christensenellaceae, Christe -senellaceae_R_7_group, Ruminococcaceae_NK4A214_group, Eggerthellaceae, Family-XIII, Family_XIII_AD3011_group, Faecalibaculum, and Oscillibacter. They were mainly involved in pathways including short-chain fatty acid (SCFA) metabolism. Among these variable bacteria taxa, Faecalibaculum was found associated with both NCPB and depressive symptoms. Furthermore, five pathways turned out to be significantly altered in both the high-status NCPB group and the depressive symptom group, including butanoate metabolism, glyoxylate and dicarboxylate metabolism, propanoate metabolism, phenylalanine, tyrosine, and tryptophan biosynthesis, valine, leucine, and isoleucine degradation. These pathways were related to SCFA metabolism.

Discussion

Fecal microbiota is altered in Chinese young male adults with high status NCPB and may be involved in the biochemical progress that influences depressive symptoms.

The combined cognitive bias hypothesis in anxiety: A systematic review and meta-analysis

Cognitive theories have postulated the relational nature of different cognitive biases in the development and maintenance of anxiety disorders. To test this combined cognitive bias hypothesis, this review addressed the following questions: (i) whether different cognitive biases are associated with each other and (ii) whether one bias influences another bias. We identified 36 articles that studied the relationship between cognitive biases (attention, interpretation and memory bias). Of these, 31 studies were entered into two meta-analyses. Sixteen studies were included in the first meta-analysis of the correlation between cognitive bias indices. A further 15 studies were included in another meta-analysis to examine the transfer effects of cognitive bias modification (CBM) to another bias. Both meta-analyses yielded small but significant overall pooled effect sizes after the removal of outliers (r = 0.11 and g = 0.19 respectively). Moderator analyses revealed that the relationship between interpretation and memory bias was significantly stronger than other types of cognitive bias correlations and CBM is more potent in modifying biases when it was delivered in the laboratory compared with online. Our review quantifies the strength of the relationships between biases and transfer effects following CBM, which serves as a basis to further understand the mechanisms underlying biased information processing.

Disentangling the mediating role of modifying interpretation bias on emotional distress using a novel cognitive bias modification program

BACKGROUND

Negative interpretation bias is a potential risk factor for emotional disorders. In this study, we tested a clinically inspired 4-session online Cognitive Bias Modification-Interpretation (CBM-I_Clin) program to modify negative interpretation biases.

METHODS

We randomized one hundred and twenty-one volunteer young adults (Mean age = 21.6 years, SD = 3.5; 85 % women) with varying levels of emotional distress to either an experimental or waitlist control group. Mediation analyses were used to disentangle the associations between the intervention, changes in interpretation biases (assessed by both a self-report and an experimental task), and changes in measures of cognitive vulnerability and symptoms of depression and anxiety.

RESULTS

The results showed that the CBM-I_Clin could change negative interpretation biases. Also, it had a direct effect on the change in negative memory bias, an indirect effect on the change in depression symptoms via the change in interpretation bias, and both direct and indirect effects on the change in self-reported dysfunctional attitudes.

LIMITATIONS

The study included a non-clinical sample of participants and it did not control for some potential confounding factors (e.g., attentional disorders). Furthermore, participants' engagement during the sessions at home was not supervised.

CONCLUSIONS

The CBM-I_Clin is a potential tool to prevent and intervene in emotional disorders in young adults and could complement other traditional CBM procedures or clinical interventions.

'Relearning how to think': A brief online intervention to modify biased interpretations in emotional disorders-study protocol for a randomised controlled trial

Background

Cognitive biases play an important role in the development and maintenance of emotional disorders, such as depression and anxiety. Novel procedures, known as Cognitive Bias Modification (CBM), aim to reduce these dysfunctional information processing modes. This study develops a brief clinically based online intervention programme to modify biased interpretations in depression and anxiety (CBM-I_Clin), overcoming some methodological issues that have been addressed in previous literature.

Methods

Volunteer participants will be recruited via social media and posters at the university. They will be randomly assigned to an experimental group or a waiting list control group. Both groups will complete two assessment sessions (before and after the intervention) consisting of questionnaires measuring cognitive and emotional variables as well as experimental tasks measuring cognitive biases (i.e. attention, memory, and interpretation). After the first assessment session, only participants in the experimental group will receive a link to follow the four CBM-I_Clin sessions at home. All participants will receive, via email, follow-up questionnaires 2 weeks and 3 months after the second assessment.

Discussion

This study will test the 'Relearning how to think', an online programme potentially beneficial to modify cognitive biases in emotional disorders. Several limitations of previous CBM procedures are addressed, and the impact of the programme both on objective cognitive bias tasks and clinical symptoms will be explored.

Trial registration

ClinicalTrials.gov NCT03987477. Prospectively registered on June 17, 2019

Interpreting ambiguous emotional information: Convergence among interpretation bias measures and unique relations with depression severity

This study aimed to examine the convergence among interpretation bias measures and their associations with depressive symptom severity. Research into interpretation biases employs measures of interpretation bias interchangeably, however, little is known about the relationship between these measures. Participants (N = 82 unselected undergraduate students; 59 female) completed four computer-based interpretation bias tasks in a cross-sectional design study. Indirect measures, based on participants' reaction times, were not correlated with each other and had poor split-half reliability. Direct measures were more strongly correlated with depressive symptoms than indirect measures, but only the Scrambled Sentences Task explained a reliable unique portion of the variance in depressive symptoms. Interpretation bias tasks may not measure the same cognitive process and may differ in the extent to which they are a cognitive marker of depression-linked interpretation bias. These findings help to improve the measurement of and theory underlying interpretation bias and depressive symptoms.

Cognitive Control, Cognitive Biases and Emotion Regulation in Depression: A New Proposal for an Integrative Interplay Model

Research traditions on cognition and depression focus on relatively unconnected aspects of cognitive functioning. On one hand, the neuropsychological perspective has concentrated on cognitive control difficulties as a prominent feature of this condition. On the other hand, the clinical psychology perspective has focused on cognitive biases and repetitive negative patterns of thinking (i.e., rumination) for emotional information. A review of the literature from both fields reveals that difficulties are more evident for mood-congruent materials, suggesting that cognitive control difficulties interact with cognitive biases to hinder cognitive switching, working memory updating, and inhibition of irrelevant information. Connecting research from these two traditions, we propose a novel integrative cognitive model of depression in which the interplay between mood-congruent cognitive control difficulties, cognitive biases, and rumination may ultimately lead to ineffective emotion-regulation strategies to downregulate negative mood and upregulate positive mood.

Affective Processing Biases in Relation to Past, Current, and Future Depression in Children and Adolescents

BACKGROUND

The affective go/no-go (AGN) task has been used to assess affective biases in attention set-shifting and deficits in inhibitory control of emotional information among depressed youth, but results have been inconsistent. We aimed to test AGN robustness and clarify temporal relationships between depressive symptoms and affective processing in youth.

METHODS

We evaluated AGN performance twice (Time 1 N = 306; Time 2 N = 238) in relation to current, previous, and future depression in the same children/adolescents with depression and those without diagnoses who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Mixed repeated ANCOVAs were powered to detect small-medium group by valence interactions in response latency and errors. Supplemental regression analyses examined depressive symptoms as a continuous variable in relation to AGN performance.

RESULTS

No clear pattern emerged, mirroring the broader AGN literature. In primary analyses, group by valence interactions were only observed at one AGN administration; none replicated across administrations. Similarly, in regression analyses depressive symptoms had no relation to affective processing biases/deficits at AGN Time 1, though some relationships were detected between symptoms and AGN Time 2.

LIMITATIONS

Relatively few youth met criteria for a depressive disorder, though analyses were appropriately powered and supplemental analyses examined depressive symptoms continuously. Comparison groups were not healthy controls at recruitment but were free from any Axis I disorder at AGN administration.

CONCLUSIONS

Given the inconsistency of AGN findings, attention should be focused on tasks that provide more sensitive, robust measures of emotional information processing in depressed youth.

Burnout is associated with a depressive interpretation style

The aim of this 188-participant study (65% female; mean age = 40.31) was to examine whether burnout and depression are associated with similar interpretation biases in the processing of emotional information. Burnout symptoms were assessed with the Maslach Burnout Inventory-General Survey and depressive symptoms with the 9-item depression module of the Patient Health Questionnaire. Interpretation bias toward emotional information was examined using an amended version of the Word-Sentence Association Paradigm (WSAP). In the WSAP, participants are asked to decide whether emotionally-valenced words are related to ambiguous sentences. Burnout and depression were each associated with a higher endorsement of negative interpretations and a higher ratio of negative interpretations to positive interpretations. Negative word endorsement and positive word endorsement interacted in such a way that negative word endorsement was predictive of burnout and depression only when positive word endorsement levels were relatively low. Our findings suggest that burnout and depression are associated with similar alterations in the interpretation of ambiguous information. This study supports the view that burned out individuals perceive the world with "depressive glasses." Cognitive bias modification techniques employed in the treatment of depressive conditions may constitute relevant therapeutic options for "burned out" individuals.

A Hot-Cold Cognitive Model of Depression: Integrating the Neuropsychological Approach Into the Cognitive Theory Framework

In the 50 years following Beck’s cognitive theory, empirical research has consistently supported the role of dysfunctional, ‘hot’ cognition in the onset and maintenance of major depressive disorder. Compromised ‘cold’ cognition in attention, memory, and executive control abilities, independent of the affective state, has attracted much clinical interest for its role throughout the course of illness and into remission. We propose integrating cold cognition into Beck’s cognitive theory framework to account for the complementary roles of both hot and cold cognition in depression onset and maintenance.

A critical review of cognitive research was conducted to inform an integrated hot-cold cognitive model of depression.

Cold cognitive deficits likely act as a gateway to facilitate the activation and expression of the hot cognitive biases through a weakened ability to attend, retrieve, and critically assess information. Cold deficits become exacerbated by the negative mood state, essentially ‘becoming hot’, lending to maladaptive emotion regulation through ruminative processes. Depleted cognitive resources contribute to the manifestation of further deficit in problem-solving ability in everyday life, which in itself, may act as a stressor for the onset of recurrent episodes, perpetuating the depressive cycle.

We discuss the interaction between hot and cold cognition within the cognitive theory framework and the potential of complementary hot-cold pathways to elucidate novel means of prevention and treatment for depression.

Dysfunction in hot (emotion-dependent) and cold (emotion-independent) cognition has been demonstrated in depression, but psychological treatment has largely focused on hot cognition only.

Hot and cold cognition are complementary processes throughout the activation and maintenance of depressive schemas and biases, necessitating the consideration of both hot and cold cognitive aspects to disrupt the depressive cycle.

The proposed hot-cold cognitive model shows promise to stimulate new research avenues for the prevention and treatment of depression.

Attentional bias and childhood maltreatment in clinical depression - An eye-tracking study

Major depressive disorder (MDD) has been found to be associated with biased attention to emotional stimuli: increased attention for dysphoric information and/or decreased attention for positive information compared to healthy individuals. A history of childhood maltreatment (CM) has been discussed as a factor that might have an impact on the occurrence and extent of biased attention in depression. The present study examined the association between CM and attention for facial emotions in currently depressed patients using eye-tracking methodology. In a free viewing paradigm, 31 individuals with MDD and 31 healthy subjects viewed images of four facial expressions (happy, sad, angry, and neutral). Dwell time on each facial expression was used as an indicator of attention allocation. Childhood maltreatment was assessed using the German version of the Childhood Trauma Questionnaire. Depressed patients showed shorter gaze durations for happy faces compared to healthy controls. This result is in line with the assumption that depression goes along with a loss of elaborative processing of positive stimuli. No group differences were observed concerning dwell times on negative faces. However, CM was associated with reduced attention for angry and sad facial expressions in the depressed sample. Depressed individuals with a history of CM seem to avoid processing of threatening or burdensome stimuli. Early life adversity appears to impact attention allocation in depressed individuals and might help to explain discordant results in the literature regarding biased attention to negative facial expressions in depression.

CBT and positive psychology interventions for clinical depression promote healthy attentional biases: An eye-tracking study

BACKGROUND

Although there is a growing interest in the role of attentional biases in depression, there are no studies assessing changes in these biases after psychotherapeutic interventions.

METHODS

We used a validated eye-tracking procedure to assess pre-post therapy changes in attentional biases toward emotional information (i.e., happy, sad, and angry faces) when presented with neutral information (i.e., neutral faces). The sample consisted of 75 participants with major depression or dysthymia. Participants were blindly assigned to one of two 10 weekly sessions of group therapy: a cognitive behavior therapy intervention (N = 41) and a positive psychology intervention (N = 34).

RESULTS

Both treatments were equally efficacious in improving depressive symptoms (p = .0001, η² = .68). A significant change in attentional performance after therapy was observed irrespective of the intervention modality. Comparison of pre-post attentional measures revealed a significant reduction in the total time of fixations (TTF) looking at negative information (i.e., sad and angry faces) and a significant increase in the TTF looking at positive information (i.e., happy faces)-all p < .02.

CONCLUSIONS

Findings reveal for the first time that psychotherapeutic interventions are associated with a significant change in attentional biases as assessed by a direct measure of attention. Furthermore, these changes seem to operate in the same direction typically found in healthy populations (i.e., a bias away from negative information and a parallel bias toward positive information). These findings illustrate the importance of considering attentional biases as clinical markers of depression and suggest the viability of modifying these biases as a potential tool for clinical change.

Memory bias toward emotional information in burnout and depression

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