Selective attention to emotional faces following recovery from depression.

This study was designed to examine attentional biases in the processing of emotional faces in currently and formerly depressed participants and healthy controls. Using a dot-probe task, the authors presented faces expressing happy or sad emotions paired with emotionally neutral faces. Whereas both currently and formerly depressed participants selectively attended to the sad faces, the control participants selectively avoided the sad faces and oriented toward the happy faces, a positive bias that was not observed for either of the depressed groups. These results indicate that attentional biases in the processing of emotional faces are evident even after individuals have recovered from a depressive episode. Implications of these findings for understanding the roles of cognitive and interpersonal functioning in depression are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concreteness training reduces dysphoria: Proof-of-principle for repeated cognitive bias modification in depression.

A tendency toward abstract and overgeneral processing is a cognitive bias hypothesized to causally contribute to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, 60 participants with dysphoria were randomly allocated either to (a) concreteness training; (b) bogus concreteness training, matched with concreteness training for treatment rationale, experimenter contact, and treatment duration but without active engagement in concrete thinking; (c) a waiting-list, no training control. Concreteness training resulted in significantly greater decreases in depressive symptoms and significantly greater increases in concrete thinking than the waiting-list and the bogus training control, and significantly greater decreases in rumination than the waiting-list control. These findings suggest that concreteness training has potential as a guided self-help intervention for mild-to-moderate depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of the effect of cognitive bias modification on anxiety and depression.

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive status impacts age-related changes in attention to novel and target events in normal adults.

In this study, the authors investigated the relationship between the cognitive status of normal adults and age-related changes in attention to novel and target events. Old, middle-age, and young subjects, divided into cognitively high and cognitively average performing groups, viewed repetitive standard stimuli, infrequent target stimuli, and unique novel visual stimuli. Subjects controlled viewing duration by a button press that led to the onset of the next stimulus. They also responded to targets by pressing a foot pedal. The amount of time spent looking at different kinds of stimuli served as a measure of visual attention and exploratory activity. Cognitively high performers spent more time viewing novel stimuli than cognitively average performers. The magnitude of the difference between cognitively high and cognitively average performing groups was largest among old subjects. Cognitively average performers had slower and less accurate responses to targets than cognitively high performers. The results provide strong evidence that the link between engagement by novelty and higher cognitive performance increases with age. Moreover, the results support the notion of there being different patterns of normal cognitive aging and the need to identify the factors that influence them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective attention to affective stimuli and clinical depression among youths: Role of anxiety and specificity of emotion.

Cognitive models of psychopathology posit that the content or focus of information-processing biases (e.g., attentional biases) is disorder specific: Depression is hypothesized to be characterized by attentional biases specifically for depression-relevant stimuli (e.g., sad facial expressions), whereas anxiety should relate particularly to attentional biases to threat-relevant stimuli (e.g., angry faces). However, little research has investigated this specificity hypothesis and none with a sample of youths. The present study examined attentional biases to emotional faces (sad, angry, and happy compared with neutral) in groups of pure depressed, pure anxious, comorbid depressed and anxious, and control youths (ages 9–17 years; N = 161). Consistent with cognitive models, pure depressed and pure anxious youths exhibited attentional biases specifically to sad and angry faces, respectively, whereas comorbid youths exhibited attentional biases to both facial expressions. In addition, control youths exhibited attentional avoidance of sad faces, and comorbid boys avoided happy faces. Overall, findings suggest that cognitive biases and processing of particular emotional information are specific to pure clinical depression and anxiety, and results inform etiological models of potentially specific processes that are associated with internalizing disorders among youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive Realism and Outcome Density Bias in Contingency Judgments: The Effect of the Context and Intertrial Interval.

The perception of the effectiveness of instrumental actions is influenced by depressed mood. Depressive realism (DR) is the claim that depressed people are particularly accurate in evaluating instrumentality. In two experiments, the authors tested the DR hypothesis using an action-outcome contingency judgment task. DR effects were a function of intertrial interval length and outcome density, suggesting that depressed mood is accompanied by reduced contextual processing rather than increased judgment accuracy. The DR effect was observed only when participants were exposed to extended periods in which no actions or outcomes occurred. This implies that DR may result from an impairment in contextual processing rather than accurate but negative expectations. Therefore, DR is consistent with a cognitive distortion view of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapeutic relationship in the brief treatment of depression: Contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysfunctional attitudes and episodes of major depression: Predictive validity and temporal stability in never-depressed, depressed, and recovered women.

In a large, community-based sample of women (N = 750), the authors examined the nature of associations between dysfunctional attitudes and depression. Dysfunctional attitudes were evaluated both as a vulnerability factor for depression and as a consequence of depression. A link was found between past depression and baseline elevations in dysfunctional attitudes that was independent of current subsyndromal symptoms, but intensification of dysfunctional attitudes following prospectively evaluated episodes of depression (depressive "scarring") was not observed. Although baseline dysfunctional attitudes predicted an episode of major depression over 3 years of prospective study, this prediction, considered alone or in interaction with negative life events, was redundant with that offered by history of past depression. Further, no significant prediction was evident for the Dysfunctional Attitude Scale (A. N. Weissman & A. T. Beck, 1978) when the formerly depressed and never-depressed cohorts were considered separately. Implications for cognitive theories are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptual and cognitive load interact to control the spatial focus of attention.

Caparos and Linnell (2009, 2010) used a variable-separation flanker paradigm to show that (a) when cognitive load is low, increasing perceptual load causes spatial attention to focus and (b) when perceptual load is high, decreasing cognitive load causes spatial attention to focus. Here, we tested whether the effects of perceptual and cognitive load on spatial focus remain when, respectively, cognitive load is high and perceptual load is low. We found that decreasing cognitive load only causes spatial attention to focus when perceptual load is high and the stimulus encourages this. Moreover, and contrary to the widely held assumption that perceptual load focuses attention automatically (Lavie, Hirst, de Fockert, & Viding, 2004), perceptual load exerts its focusing effect only with the engagement of cognitive resources when cognitive load is low. In sum, perceptual and cognitive mechanisms exert interacting effects and operate in concert to focus spatial attention. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The spatial focus of attention is controlled at perceptual and cognitive levels.

Selective attention has been hypothesized to reduce distractor interference at both perceptual and postperceptual levels (Lavie, 2005), respectively, by focusing perceptual resources on the attended location and by blocking at postperceptual levels distractors that survive perceptual selection. This study measured the impact of load on these selection mechanisms using a flanker paradigm (Eriksen & St. James, 1986) and indexing distractor interference as a function of separation. It distinguished changes in the extent of focus of the distractor-interference function of separation (reflecting perceptual selection) from changes in the amplitude of distractor interference not accompanied by changes in focus (reflecting postperceptual selection). It showed that: (1) the spatial profile of perceptual resources is shaped like a “Mexican hat” (Müller et al., 2005); (2) increasing perceptual load focuses perceptual resources (Caparos & Linnell, 2009); (3) increasing cognitive load defocuses perceptual resources; and (4) participants with reduced working-memory span show reduced postperceptual blocking of distractors. While these findings are consistent with two levels of selective attention, they show that the first perceptual level is affected not only by perceptual but also by cognitive-control mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in cognitive content during and following cognitive therapy for recurrent depression: Substantial and enduring, but not predictive of change in depressive symptoms.

The authors examined the amount and durability of change in the cognitive content of 156 adult outpatients with recurrent major depressive disorder after treatment with cognitive therapy. The pre-post magnitude of change was large for the Attributional Style Questionnaire Failure composite (d = 0.79), Dysfunctional Attitudes Scale (d = 1.05), and Self-Efficacy Scale (d = 0.83), and small for the Attributional Style Questionnaire Success composite (d = 0.30). Changes in cognitive content were clinically significant, as defined by their 64%-87% scores overlapping with score distributions from community dwellers. Improvement was durable over a 2-year follow-up. Changes in negative cognitive content could be detected early and distinguished responders from nonresponders. In responders, continuation-phase cognitive therapy was associated with further improvements on only 1 measure of cognitive content. Early changes in negative cognitive content did not predict later changes in depressive symptoms, which the authors discuss in the context of methodological challenges and the cognitive theory of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of a single-session attention modification program on response to a public-speaking challenge in socially anxious individuals.

Research suggests that individuals with social anxiety show an attention bias for threat-relevant information However, few studies have directly manipulated attention to examine its effect on anxiety. In the current article, the authors tested the hypothesis that an attention modification program would be effective in reducing anxiety response and improving performance on a public-speaking challenge. Socially anxious participants completed a probe detection task by identifying letters (E or F) replacing one member of a pair of faces (neutral or disgust). The authors trained attention by including a contingency between the location of the neutral face and the probe in one group (Attention Modification Program; AMP). Participants in the AMP group showed significantly less attention bias to threat after training and lower levels of anxiety in response to a public-speaking challenge than did the participants in the Attention Control Condition (ACC) group. Moreover, blind raters judged the speeches of those in the AMP group as better than those in the ACC group. These results are consistent with the hypothesis that attention plays a causal role in the maintenance of social anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metacognitive awareness and prevention of relapse in depression: Empirical evidence.

Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (1) reduced metacognitive awareness would be associated with vulnerability to depression and (2) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (1) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (2) accessibility of metacognitive sets predicted relapse in residually depressed patients; (3) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (4) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of ambivalent coping to depression symptoms and adjustment.

Objective: To assess the influence of mental distancing and venting emotions on depressive symptoms and health-related quality of life (HRQOL). Participants: Seventy-six individuals hospitalized with acute burn injuries. Design: Prospective longitudinal study. Measures: Beck Depression Inventory (A. T. Beck, E. Ward, M. Mendelson, J. Mock, & J. Erbaugh, 1961), COPE (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989), and Short Form--36 Health Survey (J. E. Ware, K. K. Snow, M. Kosinski, & B. Gandek, 1993). Results: Ambivalent coping at baseline (i.e., using both mental distancing and venting emotions, relative to using only 1 or neither) led to more symptoms of depression at follow-up, even when baseline symptoms were controlled. Ambivalent coping was related to postburn psychosocial HRQOL, and baseline symptoms of depression only slightly attenuated this relationship. Conclusions: Ambivalent coping appears to result from vacillation between motives. Decreasing inconsistent coping or reducing antithetical motivation may reduce depression and improve adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Allocation of spatial attention to emotional stimuli depends upon arousal and not valence.

Attentional allocation to emotional stimuli is often proposed to be driven by valence and in particular by negativity. However, many negative stimuli are also arousing leaving the question whether valence or arousal accounts for this effect. The authors examined whether the valence or the arousal level of emotional stimuli influences the allocation of spatial attention using a modified spatial cueing task. Participants responded to targets that were preceded by cues consisting of emotional pictures varying on arousal and valence. Response latencies showed that disengagement of spatial attention was slower for stimuli high in arousal than for stimuli low in arousal. The effect was independent of the valence of the pictures and not gender-specific. The findings support the idea that arousal affects the allocation of attention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disengaging attention: On the locus of the cue-duration effect in partial report.

Increasing cue duration impairs performance in bar-probe partial report when cues are presented peripherally, but not centrally (P. Dixon, R. Gordon, A. Leung, & V. Di Lollo, 1997). Three experiments examined whether this cue-duration effect reflects processes of exogenous attention. The effect of cue duration on partial report performance with peripheral, but not central, cues was replicated (Experiment 1). Further experiments manipulated the degree that exogenous versus endogenous modes of selection were favored and found that the cue-duration effect for peripheral cues was reduced (1) when blocks contained a high proportion of central cues (Experiment 2) and (2) when the color of the cue indicated the location of the target (Experiment 3). These findings challenge the view that the cue-duration effect is restricted to exogenous attention and are discussed in terms of the process of disengaging attention from the cue to reallocate attention to the target representation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains in cognitive therapy of depression and depression relapse/recurrence.

Cognitive therapy (CT) may have significant advantages over antidepressants in preventing depression relapses. Many CT patients experience sudden gains: large symptom improvement in 1 between-session interval. Past studies have associated CT sudden gains with in-session cognitive changes but not with life events. This study examined sudden gains and depression relapse/recurrence among 60 CT clinical-trial patients. Survival analyses showed that only one third of sudden-gain-responders relapsed in 2 years, and they had 74% lower relapse risks than did non-sudden-gain-responders. Among patients with sustained responses, 73% experienced sudden gains. The authors also replicated J. R. Vittengl, L. A. Clark, and R. B. Jarrett's (see record 2005-01321-021) finding that sudden gains identified with their unique criteria did not predict relapse. The current authors' findings suggest that CT sudden gains are not measurement artifacts, and that sudden gains and their causes and consequences might be important in preventing relapses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergence of attributional style and its relation to depressive symptoms.

The development of depressive attributional style (AS) and its role as a cognitive diathesis for depression were examined in children and adolescents (Grades 2-9). In a 4-wave longitudinal study of 3 overlapping age cohorts, AS, negative life events, and depressive symptoms were evaluated every 12 months. Consistency of children's attributions across situations was moderately high at all ages. The cross-sectional structure of AS changed with age, as stability became a more salient aspect of AS than internality and globality. The structure of AS also changed, becoming more traitlike as children grew older. In longitudinal analyses, evidence of a Cognitive Diathesis × Stress interaction did not emerge until Grades 8 and 9, suggesting that AS may not serve as a diathesis for depression at younger ages. Results suggest that attributional models of depression may require modification before they are applied across developmental levels. (PsycINFO Database Record (c) 2010 APA, all rights reserved)