Jonas Everaert

The combined cognitive bias hypothesis in depression

Drawing from substantial evidence demonstrating cognitive biases in depression at various stages of information processing (i.e., attention, interpretation, memory, cognitive control), we argue for an approach that considers the interplay among these processes. This paper attempts to apply the combined cognitive bias hypothesis (Hirsch, Clark, & Mathews, 2006) to depression research and reviews competing theoretical frameworks that have guided research in this area. We draw on current findings from behavioral studies on the interplay between depression-related processing biases. These data indicate that various cognitive biases are associated. However, it is not clear whether single or multiple biases are most predictive of depressive symptoms. We conclude this article with theoretical and clinical implications of the current state of research in this field and propose a number of ways in which research on the combined cognitive bias hypothesis can be advanced.

Attention, interpretation, and memory biases in subclinical depression: a proof-of-principle test of the combined cognitive biases hypothesis.

Emotional biases in attention, interpretation, and memory are viewed as important cognitive processes underlying symptoms of depression. To date, there is a limited understanding of the interplay among these processing biases. This study tested the dependence of memory on depression-related biases in attention and interpretation. Subclinically depressed and nondepressed participants completed a computerized version of the scrambled sentences test (measuring interpretation bias) while their eye movements were recorded (measuring attention bias). This task was followed by an incidental free recall test of previously constructed interpretations (measuring memory bias). Path analysis revealed a good fit for the model in which selective orienting of attention was associated with interpretation bias, which in turn was associated with a congruent bias in memory. Also, a good fit was observed for a path model in which biases in the maintenance of attention and interpretation were associated with memory bias. Both path models attained a superior fit compared with path models without the theorized functional relations among processing biases. These findings enhance understanding of how mechanisms of attention and interpretation regulate what is remembered. As such, they offer support for the combined cognitive biases hypothesis or the notion that emotionally biased cognitive processes are not isolated mechanisms but instead influence each other. Implications for theoretical models and emotion regulation across the spectrum of depressive symptoms are discussed.

The Indirect Effect of Attention Bias on Memory via Interpretation Bias: Evidence for the Combined Cognitive Bias Hypothesis in Subclinical Depression.

Little research has investigated functional relations among attention, interpretation, and memory biases in depressed samples. The present study tested the indirect effect of attention bias on memory through interpretation bias as an intervening variable in a mixed sample of non-depressed and subclinically depressed individuals. Subclinically depressed and non-depressed individuals completed a spatial cueing task (to measure attention bias), followed by a scrambled sentences test (to measure interpretation bias), and an incidental free recall task (to measure memory bias). Bias-corrected bootstrapping yielded evidence for the hypothesised indirect effect model, in that an emotional bias in attention is related to a congruent bias in interpretative choices which are in turn reflected in memory. These findings extend previous research and provide further support for the combined cognitive bias hypothesis in depression. Theoretical and clinical implications of our findings are discussed.

Internal cognitive control in clinical depression: General but no emotion-specific impairments

Prior research has suggested that depression is characterized by impaired cognitive control. The present study sought to investigate internal cognitive control impairments related to emotional information and task settings in clinical depression (MDD, major depressive disorder). Internal cognitive control was operationalized as switching between internally held mental representations that required continuous updating in working memory and measured with the Internal Shift Task (IST). The results showed that MDD individuals were characterized by a general switching impairment. This switching impairment was neither influenced by the task-relevance of emotional information, nor influenced by the valence of the faces within the emotion condition. The impairment in cognitive control reflected in general switching impairments was related to rumination, a specific cognitive symptom and important risk factor of depression. The results of this study offer new insights into the relationship between depression and impaired cognitive control with potential clinical implications, informing treatment and prevention programmes.

Attention bias modification via single-session dot-probe training: failures to replicate

BACKGROUND AND OBJECTIVES Across three experiments we investigated transfer effects of single-session attention bias modification via dot-probe training. METHODS In experiment 1, participants received training either toward or away from negative images or no-training, and transfer to an affective task-switching task was examined. In two other experiments, participants were trained to orient attention toward either positive or negative words (experiment 2a) or facial expressions (experiment 2b), and transfer to an interpretation bias task was examined. RESULTS In all experiments, the dot-probe training procedure did not effectively modify biases in attention allocation at the training condition level, but produced a large variability in individual attention bias acquisition within and across conditions. Individual differences in pre-training attention bias and attention bias acquisition were not related to performance on the affective task-switching task or the interpretation tasks. LIMITATIONS The present investigations are limited by the lack of effectiveness of ABM at the condition level, the order in which transfer tasks were administered, and the restricted range of affective symptoms that could moderate training and transfer effects. CONCLUSIONS The findings from three experiments provided no evidence for single-session dot-probe ABM procedures to effectively manipulate attention bias toward negative, away from negative, or toward positive stimuli at a training condition level. At the individual differences level of analysis, again no evidence was found for transfer of attention training. The observations invite further empirical scrutiny into factors that moderate attentional plasticity in response to dot-probe ABM procedures to optimize the conditions for effective implementation and transfer of training.

Individual differences in cognitive control over emotional material modulate cognitive biases linked to depressive symptoms

ABSTRACT Deficient cognitive control over emotional material and cognitive biases are important mechanisms underlying depression, but the interplay between these emotionally distorted cognitive processes in relation to depressive symptoms is not well understood. This study investigated the relations among deficient cognitive control of emotional information (i.e. inhibition, shifting, and updating difficulties), cognitive biases (i.e. negative attention and interpretation biases), and depressive symptoms. Theory-driven indirect effect models were constructed, hypothesising that deficient cognitive control over emotional material predicts depressive symptoms through negative attention and interpretation biases. Bootstrapping analyses demonstrated that deficient inhibitory control over negative material was related to negative attention bias which in turn predicted a congruent bias in interpretation and subsequently depressive symptoms. Both shifting and updating impairments in response to negative material had an indirect effect on depression severity through negative interpretation bias. No evidence was found for direct effects of deficient cognitive control over emotional material on depressive symptoms. These findings may help to formulate an integrated understanding of the cognitive foundations of depressive symptoms.

Mapping the interplay among cognitive biases, emotion regulation, and depressive symptoms.

ABSTRACT Cognitive biases and emotion regulation (ER) difficulties have been instrumental in understanding hallmark features of depression. However, little is known about the interplay among these important risk factors to depression. This cross-sectional study investigated how multiple cognitive biases modulate the habitual use of ER processes and how ER habits subsequently regulate depressive symptoms. All participants first executed a computerised version of the scrambled sentences test (interpretation bias measure) while their eye movements were registered (attention bias measure) and then completed questionnaires assessing positive reappraisal, brooding, and depressive symptoms. Path and bootstrapping analyses supported both direct effects of cognitive biases on depressive symptoms and indirect effects via the use of brooding and via the use of reappraisal that was in turn related to the use of brooding. These findings help to formulate a better understanding of how cognitive biases and ER habits interact to maintain depressive symptoms.

Emotionally Biased Cognitive Processes: The Weakest Link Predicts Prospective Changes in Depressive Symptom Severity

Emotional biases in attention, interpretation, and memory are predictive of future depressive symptoms. It remains unknown, however, how these biased cognitive processes interact to predict depressive symptom levels in the long-term. In the present study, we tested the predictive value of two integrative approaches to model relations between multiple biased cognitive processes, namely the additive (i.e., cognitive processes have a cumulative effect) vs. the weakest link (i.e., the dominant pathogenic process is important) model. We also tested whether these integrative models interacted with perceived stress to predict prospective changes in depressive symptom severity. At Time 1, participants completed measures of depressive symptom severity and emotional biases in attention, interpretation, and memory. At Time 2, one year later, participants were reassessed to determine depressive symptom levels and perceived stress. Results revealed that the weakest link model had incremental validity over the additive model in predicting prospective changes in depressive symptoms, though both models explained a significant proportion of variance in the change in depressive symptoms from Time 1 to Time 2. None of the integrative models interacted with perceived stress to predict changes in depressive symptomatology. These findings suggest that the best cognitive marker of the evolution in depressive symptoms is the cognitive process that is dominantly biased toward negative material, which operates independent from experienced stress. This highlights the importance of considering idiographic cognitive profiles with multiple cognitive processes for understanding and modifying effects of cognitive biases in depression.

Life is… great! : emotional attention during instructed and uninstructed ambiguity resolution in relation to depressive symptoms

Attention and interpretation biases are closely involved in depression. However, it is unclear whether they reflect processing tendencies (i.e., driven by schemas) and/or ability-related processes (i.e., dependent on attentional control). This study tested depressive symptom severity, attention bias, and interpretation bias associations under both processing conditions. Fifty-two participants completed two versions of the scrambled sentences test (to measure interpretation bias) while eye movements were recorded (to measure attention bias). Participants were instructed to unscramble sentences by reporting the first sentence coming to mind (tendency version) and in a fixed, positive manner (ability version). Depressive symptom severity was correlated with attention bias under both conditions. Attention bias acted as an intervening variable in the relation between depressive symptoms and interpretation bias during ability processes. These findings suggest that attention biases reflect both processing tendencies and ability dysfunctions, with attentional control as a relevant mechanism in the interpretation of emotional material.

Attention training through gaze-contingent feedback: effects on reappraisal and negative emotions

Reappraisal is central to emotion regulation but its mechanisms are unclear. This study tested the theoretical prediction that emotional attention bias is linked to reappraisal of negative emotion-eliciting stimuli and subsequent emotional responding using a novel attentional control training. Thirty-six undergraduates were randomly assigned to either the control or the attention training condition and were provided with different task instructions while they performed an interpretation task. Whereas control participants freely created interpretations, participants in the training condition were instructed to allocate attention toward positive words to efficiently create positive interpretations (i.e., recruiting attentional control) while they were provided with gaze-contingent feedback on their viewing behavior. Transfer to attention bias and reappraisal success was evaluated using a dot-probe task and an emotion regulation task which were administered before and after the training. The training condition was effective at increasing attentional control and resulted in beneficial effects on the transfer tasks. Analyses supported a serial indirect effect with larger attentional control acquisition in the training condition leading to negative attention bias reduction, in turn predicting greater reappraisal success which reduced negative emotions. Our results indicate that attentional mechanisms influence the use of reappraisal strategies and its impact on negative emotions. The novel attention training highlights the importance of tailored feedback to train attentional control. The findings provide an important step toward personalized delivery of attention training. (PsycINFO Database Record