Data curation, [30], we calculated 5 indices of TL-BS based on the derived pairings for each stimulus type per 2 presentation times (40 TL-BS indices in total) which indicated individual differences in phasic bursts or “peaks” of AB expression, mean levels of TL-BS toward and away from target stimuli, and degree of TL-BS variability over time across the spectrum of AB (away, towards, or both). Yes When a participant gave a wrong response, a red rectangle with the word wrong in capitals appeared for 500 ms in the middle of the screen. Also when indexed by trial-level bias scores (iii) there was no evidence for a relatively strong AB for negative adjectives in participants with MDD or mixed MDD/AD; (iv) specifically the mixed MDD/AD group showed higher and more variable mean AB scores towards shortly (500 ms) and away from longer (1250 ms) presented general threat words than the no MDD/AD comparison group; (v) The mixed MDD/AD group showed more variability on positive word trials, and specifically for the longer presentation trials (1250 ms) also higher scores for the AB index away from positive adjectives than the comparison group. Controls, non-depressed and depressed OCD patients … Recently, evidence on the basis of a simulation study pointed to potential problems of the current TL-BS approach. A Monte Carlo simulation study demonstrated that TL-BS indices could be prone to result in false positive group differences; the differences between groups might in fact reflect differences in mean RT and or differences in overall SD [33]. We deliberately choose to select participants with MDD and without dysthymia, allowing to specifically test AB in MDD per se. The MDD group (mean difference 0.48 (s.e. None of the analyses using the traditional AB indices showed a specific AB in the mixed group, neither for negative nor for positive stimuli. Non-response was considered a missing value and was discarded. We presumed that participants with MDD (with and without ADs) would show weaker AB for positive adjectives independent of presentation time. The concept of attentional bias (AB) toward mood-congruent stimuli refers to a differential allocation of attentional resources toward emotional stimuli (e.g., sad faces) compared to neutral stimuli (e.g., neutral faces… It would be important for future research to test whether attentional biases for negative adjectives and/or general threat stimuli are predictive for the recurrence of depression. Furthermore, in participants with MDD, higher levels of AB for sad faces, as measured with an exogenous cueing task (ECT), was related to impaired mood recovery in reaction to a sad mood induction [18]. PLOS ONE promises fair, rigorous peer review, [58, 59]). Project administration, We computed trial-level bias scores (TL-BS) based on the computational methodology of Zvielli et al. (2018) Attentional bias for negative, positive, and threat words in current and remitted depression. Implications of these results for research on selective attention in depression are discussed. This study aims to clarify the presence of these ABs among individuals with clinical and subclinical depression. Methods: Attentional bias toward happy and sad faces in healthy (N = 26) and subclinically depressed individuals (N = 22) was assessed via a neuroimaging dot-probe attention task. Together, these findings point to the relevance of using different categories of emotionally relevant stimuli to examine AB in depression. Bonferroni adjusted post hoc tests indicated that for TL-BS Variability Neutral 500 ms none of the groups differences were significant. Despite immense research investment to improve existing treatment and prevention interventions, meta-analyses show that effect-sizes of these treatments remain rather small [1, 2, 3, 4]. The two-year follow-up assessment consisted of a face-to-face clinic visit, in which baseline assessments–except those concerning stable concepts–were repeated. For instance, in the context of a free-viewing task, clinically depressed young adults spent less time looking at positive images than never depressed participants [14]. Zvielli et al. The study was supported by Accare; institution for children- and adolescent psychiatry. Published by Elsevier Inc. 0.52), p = .96, 95% CI [-1.47; 1.01], d = 0.07) nor the rMDD group (mean difference 0.18 (s.e. To examine whether in line with predictions, the effect of group was mainly due to more extreme AB for threat in the mixed MDD/AD group we used Dunnett’s method for multiple comparisons (two sided). Funding: The infrastructure for the NESDA study ( has been funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002; and participating universities (VU University Medical Center, Leiden University Medical Center, University Medical Center Groningen). Attentional engagement and disengagement toward positive information were not associated with anhedonia. They were asked to ignore any other information that would be presented. However, this does not seem to be a very convincing explanation, since the mixed group that was included in the current design did not show an AB for negative adjectives either. Validation, Thus, any differential effect that may be found in the current study should be considered in light of these conceptual criticisms. It is noteworthy, though, that the current sample size is an improvement on many of the previous studies. Fifth, we translated the TL-BS from a VPT using 3 categories to this ECT using 4 categories of stimuli. After completing the assessment, participants were compensated with a €15 gift certificate and travel expenses. In a complementary approach, to test the temporal dynamics of the stimulus specificity of AB between the groups for the different stimuli types, we subjected (absolute) mean TL-BS scores and (absolute) peak TL-BS scores, and TL-BS Variability to similar MANOVA’s with TL-BS indices as dependent factor and Group (Comparison, rMDD, MDD, and MDD/AD) as fixed factor. Software, The outcomes include measures of depression, anxiety, and anhedonia; cognitive tests; and biological markers of inflammation and neurotransmitter turnover. Data curation, For all other AB scores there was no statistically significant between group difference; AB Negative 500 ms (F (3, 853) = 1.66, p = .17, partial η2 = .006), AB Positive 500 ms (F (3,853) = 0.86, p = .45, partial η2 = .003), AB Positive 1250 ms (F (3, 853) = 0.99, p = .39, partial η2 = .003), Threat 1250 ms (F (3, 853) = 1.63, p = .18, partial η2 = .006). Additionally, it is unclear whether comorbid depression modulates abnormal emotional processing in OCD. For threat words there were significant differences between groups for Threat Towards 500 ms F (3,734) = 4.80, p = .003, partial η2 = .01 and for Threat Away 1250 ms F (3,734) = 2.68, p = .04 partial η2 = .01. If AB for negative adjectives and/or general threat stimuli would set people at risk for recurrence, this would provide an important lead for clinicians to better tailor their interventions to prevent recurrent episodes of both depressive and anxiety disorders. Table 4 shows the significant post hoc contrasts for the analyses of the traditional AB scores as well as of the TL-BS indices. Stroebe for her helpful comments and suggestions. Although the TL-BS approach showed promising results in terms of prognostic value, it also gave rise to major conceptual criticisms. The mean of the median reaction times per stimulus type and the cue validity effects are displayed in Table 2 as a function of trial type (valid vs. invalid; short vs. long duration) and group. By continuing you agree to the use of cookies. However, since most evidence is based on analogue research or small heterogeneous clinical samples (e.g., [19], it remains important to test the robustness of this pattern in well-defined clinical samples. As you might imagine, this type of bias can have a dramatic impact on the decision-making process and can lead people to make bad or inaccurate choices. According to the cognitive model of depression, patients with depression exhibit a negative attentional bias that is manifested by their prioritization of negative cognitive stimuli. Copyright: © 2018 Elgersma et al. The second aim of this study relates to the temporal unfolding of attentional bias as stimuli are presented for longer presentation times. Post-stroke depression increases the likelihood of adverse physical symptoms. The task used in this study was modelled after the ECT used in previous research on anxiety and depression (e.g., [42, 43, 44]). According to cognitive models of depression, selective attentional biases (ABs) for mood-congruent information are core vulnerability factors of depression maintenance. For the other indices of threat stimuli there were no significant between group differences (Threat Away 500 ms F (3,734) = .62, p = .60 partial η2 = .003; Threat Towards 1250 ms F (3,734) = 1.89, p = .13, partial η2 = .008). This attentional bias feeds, reinforces, and prolongs depressive thought patterns, and serves as an underlying risk factor for depressive symptom onset and relapse. Thus far, AB research in depression has mainly focused on the attentional preference for negative versus positive information (for a review, see [11], whereas studies investigating AB in anxiety disorders (AD)s typically relied on (disorder-specific) threatening information (e.g., [20, 21,22]. In addition, an earlier study using a visual probe task depicting words, found that participants who were diagnosed with Dysthymia or MDD showed an AB for socially threatening words [19]. In this way, the ECT measured the tendency to automatically (non-intentionally) focus attention on stimuli; perhaps more controlled (overt) spontaneous AB processes that can be indexed in free viewing tasks (e.g.,[61]) are more important in MDD. The same fixed random order of trials was used for all participants to make the design more sensitive to individual differences. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Attentional biases in depression: Relation to disorder severity, rumination, and anhedonia. Participants also completed trait and state psychological measures and provided saliva samples for cortisol analysis. In other words, anxious individuals seemed to have an attentional bias towards negative information, leading them to become distracted by such images, whereas depressed and healthy participants were not. Previous studies in currently depressed individuals suggest attentional biases pertain specifically to sad/dysphoric stimuli, while threat-related stimuli elicit attentional biases in currently anxious individuals (Gotlib et al., 2004). The obtained results are in line with the hypothesis that depression is associated with an inhibitory deficit for negative information. For TL-BS Mean Threat 1250 ms Away we found the same pattern; the mixed MDD/AD group showed higher scores than the comparison group (mean difference 0.71 (s.e. In support of the view that AB in MDD is not merely due to comorbid anxiety disorders, one of the studies that was included in this meta-analysis showed that MDD participants with no comorbid panic disorder or social phobia (n = 88) displayed a stronger AB for sad faces (within the context of a visual probe study with happy, sad, and angry faces) than participants with only social phobia (n = 35) and participants without MDD or social phobia (n = 55) [13]. Visualization, This study was conducted as part of the Netherlands Study of Depression and Anxiety (NESDA) [34], an ongoing multi-centre, longitudinal cohort study designed to examine the long-term course and consequences of anxiety and depressive disorders. Attentional bias is described as the preferential attention toward certain types of (emotional) information in the environment. Cues (words) and targets (black squares) were presented in the center of the placeholders. 0.14), p = .37, 95% CI [-.13; 0.55], d = 0.10), the TL-BS Mean Threat 1250 ms Away scores differd from those of the comparison group. The threatening and neutral words were selected from earlier studies on AB [45, 46]. The threat bias in the mixed group could also be a premorbid characteristic, one that might have contributed to the development of the anxiety symptoms in this group via enhancing anxiety vulnerability (cf. First, we used the ECT to measure AB; just like VPT, this paradigm is not optimally suited to differentiate between enhanced engagement and difficulty to disengage. To the extent that one is willing to see less IoR (and thus less bias away from negative stimuli) as a stronger inclination to dwell on negative stimuli (cf. Data Availability: According to European law (AVG) data contain potentially identifying or sensitive patient information are restricted; our data involving clinical participants are not freely available in the manuscript, supplemental files, or in a public repository. The ECT was introduced during the 2-year follow up measurements and was completed by 2128 out of 2596 (81.97%) participants (61.9% female; mean age 43.63 years, SD = 14.06); 468 (18.02%) participants had no or too little ECT data (e.g., those interviewed over the phone or at home). Based on this view, Zvielli, et al. were more revealing of attentional bias than were emotional words and scene images [27]. Because indices were positively skewed, variables were subjected to a square root transformation, before being used in the analyses. 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. Consistent with the view that AB is involved in depression, findings of a meta-analysis covering 29 empirical studies using emotional Stroop or dot probe tasks in individuals with depressive complaints (clinical depression, nonclinical dysphoria, induced depressive mood) havorted the view that depression is associated with biased attention to negative information [12]. A study testing AB in dysphoric vs. non-dysphoric students showed that the AB for negative adjectives was especially prominent during relatively long presentation times (1500 ms), and absent during relatively short presentation times (250 ms) [24]. These groups consisted of participants with pure MDD without a history of AD, participants with both MDD and AD (mixed group), and individuals who were remitted from MDD (rMDD). Yes General exclusion criteria were presence of a psychiatric disorder other than depressive or AD (e.g., psychosis, bipolar disorder, severe addictive disorder) or lack of fluency in Dutch. 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. 0.37), p = .29, 95% CI [-.29; 1.49], d = 0.29) nor the rMDD group (mean difference 0.20 (s.e. It seems plausible that the mixed results of AB studies in participants with MDD, rMDD and/or the mixed participants can be untangled using the temporal dynamics of AB. Only for this AB index, the effect of group was significant (F (3,853) = 3.51, p = .01, partial η2 = .01). Negative attentional bias has been well established in depression. We therefore measured AB both for shorter and longer presentation times. For TL-BS Mean Threat 500 ms Towards, the mixed MDD/AD group showed significantly higher scores than the comparison group with a mean difference of 1.05 (s.e. Bonferroni adjusted post hoc between group tests indicated that for TL-BS Variability Positive 500 ms the comparison group and the mixed MDD/AD group differed significantly with a mean difference of 0.76 (s.e. In this study, we tested the robustness of these earlier findings by comparing a large group of rMDD to never-depressed individuals with regard to their AB for positive and negative adjectives, as well as for general threat words. For more information about PLOS Subject Areas, click The number of trial types among which pairings have to be made is increased considerably from 3 in the dot probe task to 8 in the currently analyzed ECT. No, Is the Subject Area "Sensory cues" applicable to this article? We used this same method to match each valid trial to a subsequently presented invalid trial. Methodology, This involved a comparison of the AB index between each of the (sub)clinical groups and the comparison group [56]. After this process, participants were asked to sign the consent form. Furthermore, the total sample of participants with MDD was too small to reliably examine sex differences in AB. Zvielli et al. In the first half of the task, word cues were presented for 500 ms, in the second half of the task for 1250 ms. We preferred a fixed order to minimize method variance which we considered important in light of the prospective design of the NESDA study (cf.[49]). This strategy meant that we had to exclude a high number of individuals (suffering from MDD and dysthymia) and that the severity of depressive symptoms was less in the current MDD group than in the comorbid group. This attention bias of information processing plays a crucial role in the pathogenesis, maintenance, and development of depression (11, 12). See Table 5 for zero-order correlations. This study aimed to examine the impact of oxytocin on attentional processes to social faces representing anger, disgust, and happiness in patients with anorexia nervosa. Validation, Unexpectedly, also the rMDD group showed more variability than the comparison group with a mean difference of 0.35 (s.e. [30]proposed that the concept of AB as a stable process (based on an averaged AB across trials within a task) may not reflect the dynamic expression of AB; “AB may be expressed in fluctuating, phasic bursts, toward or away from target stimuli over time” (p.774). 0.13), p < .03, 95% CI [0.02; 0.68], d = 0.18 (see Table 4). A disorder was considered current if participants suffered from it in the past month. We considered indices deviating more than 3 SDs from the mean of the group as outliers for all the groups. This pattern indicates that for presentation times 1250 ms the mixed MDD/AD group showed more extreme scores on TL-BS away from positive adjectives than the comparison group. The between subject tests indicated that for the negative adjectives none of the TL-BS scores showed a significant difference between groups (Negative Away 500 ms F (3,734) = 1.20, p = .30, partial η2 = .005; Negative Towards 1250 ms F (3,734) = 1.68, p = .16, partial η2 = .007, and Negative Away 1250 ms F (3,734) = 1.15, p = .32, partial η2 = .005), though for Negative Towards 500 ms this just fell short of the conventional level of significance (Negative Towards 500 ms F (3,734) = 2.38, p = .06, partial η2 = .01). Interestingly, the rMDD group showed reduced inhibition of return for negative adjectives (and thus less bias away from negative adjectives) than the comparison group as reflected in higher (less negative) traditional AB scores than the comparison group. Formal analysis, Subsequent research among nonclinical participants found similar results [25] suggesting that AB in depression may reflect a difficulty in disengaging from negative information rather than enhancing orientation/engagement. Thus, the current results for a well-defined clinical group of participants with MDD selected from a large multi-center sample did not corroborate previous research using a similar ECT in high versus low dysphoric students [24]. The difference between groups for Neutral 500 ms just fell short of significance (F (3,871) = 2.53, p = .05, partial η2 = .009). The MANOVA showed a significant multivariate effect of group (Wilks’ λ = .95, F (24, 2506) = 1.82, p < .01, partial η2 = .01. According to the cognitive model of depression, patients with depression exhibit a negative attentional bias that is manifested by their prioritization of negative cognitive stimuli. This study aims to investigate the acute and chronic effects of a dietary intervention of 22 g freeze-dried whole wild blueberry powder. here. Finally, as this study used a cross sectional design, it is not possible to draw conclusions about the direction of the relationships that were evident in this study. An incorrect response was also discarded. 3.35), p = .04, 95% CI [0.20, 17.93], d = 0.20) (see also Table 4 for all significant between group contrasts). Department of Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands, Roles Statistical analyses were run on 96.24% of the data. This pattern of findings with regard to the threat stimuli is consistent with a vigilance-avoidance pattern that has been previously reported in the context of threat scenes (e.g., [57]). Neither the MDD group (mean difference = -0.22 (s.e. Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands, Roles Validation, Writing – review & editing, Affiliation To examine whether in line with predictions, the effect of group was mainly due to more variability for threat in the mixed MDD/AD group we used Dunnett’s method for multiple comparisons (two sided). After full verbal and written information about the study, written informed consent was obtained from all participants at the start of baseline assessment. Attentional biases may explain an individual's failure to consider alternative possibilities when occupied with an existing train of thought. Trials with less than 10 reaction times were discarded. This was true for both AB quantified by traditional AB indices, and AB quantified by trial-level bias scores (TL-BS). No, Is the Subject Area "Medical risk factors" applicable to this article? Writing – review & editing, Affiliation For the neutral words there was an unexpected yet significant difference between groups for Neutral 1250 ms (F (3,871) = 4.11, p = .007, partial η2 = .01). The current study concerns secondary analyses and the number of participants available for the current analyses was thus not based on the initial power analysis that determined the sample size of the cohort that was included in NESDA. The ECT is a reaction-time based attention task which was programmed using the E-Prime 1.0.2 software (Psychology Software Tools, Pittsburgh, PA). Each trial started with the presentation of the fixation cross and the two placeholders for 500 ms. Next, a word cue was presented in the left or right placeholder, for 500 ms (short presentation time) or 1250 ms (long presentation time). Supervision, Also for TL-BS Variability Threat 1250 ms the mixed MDD/AD group showed significantly more variability than the comparison group with a mean difference of 0.75 (s.e. We investigated both stimulus specificity and time course of AB in these groups, adopting a cross-sectional design. Brooding, anhedonia, and anxiety were also evaluated. The first aim of this study is to examine AB and its stimulus specificity within an adult sample of clinically diagnosed patients with MDD. In total, the task consisted of 4 stimulus types x 16 exemplars x 2 valid/invalid x 2 presentation times = 256 word trials, 10 practice trials and 20 digit trials. For longer duration trials, specifically the mixed MDD/AD group showed heightened scores for the index of mean AB away from threat stimuli. We matched each invalid trial with a subsequently presented valid trial (thus, in a single direction from the beginning to the end of the task), temporally as close as possible and no further than 9 trials away from each other, for each stimulus type. Roles Similarly, the current results also seem at odds with previous work in clinical groups of participants with MDD which did show an attentional bias for negative stimuli as indexed by sad and angry faces [29, 44]. Attentional bias has also been associated with clinically relevant symptoms such as anxiety and depressi… Participants were recruited from the general population, through general practitioners, and in mental health care institutions, and included: healthy individuals with no history of psychiatric disorders, individuals at risk because of prior episodes, sub-threshold symptoms or family history, and individuals with a current first or recurrent MDD or AD. Attentional bias refers to how a person's perception is affected by selective factors in their attention. ... Attentional Bias Medicine & Life Sciences. This study was designed to examine selective processing of emotional information in depression. The MANOVA showed a significant multivariate effect of group (Wilks’ λ = .88, F (48, 2139) = 1.83, p < .001, partial η2 = .03). Yes Such attentional bias occurs for both pictorial emo- tional stimuli [18, 20] and emotional words, and is related to maladaptive forms of emotional regulation in depression, such as increased rumination [22, 23] and a reduced use of reappraisal strategies [24, 25]. Thus, although our findings did not provide straightforward support for the usefulness of TL-BS as an index of the temporal dynamics in AB that might have superior power over traditional AB indices on negative adjectives to differentiate between groups, it cannot be seen as a critical challenge to the relevance of indices that take temporal dynamics into account. Attentional disengagement toward sad information was not associated with brooding. 0.41), p = .95, 95% CI [-0.81; 1.18], d = 0.08) nor the rMDD group (mean difference 0.28 (s.e. 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.

attentional bias depression

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