Recently, evidence on the basis of a simulation study pointed to potential problems of the current TL-BS approach. https://doi.org/10.1371/journal.pone.0205154.t001. Directly after responding, the next trial started. https://doi.org/10.1371/journal.pone.0205154.t002. This study was designed to examine selective processing of emotional information in depression. Depression is a common and severe mental disorder. Yet, a recent analogue study showed that participants who reported both symptoms of anxiety and depression displayed an AB for emotional words, whereas participants who only reported heightened symptoms of depression did not . Participants also completed trait and state psychological measures and provided saliva samples for cortisol analysis. 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 . Depressed and healthy participants demonstrated no such effect. Yes 0.35), p = .42, 95% CI [-0.36; 1.34], d = 0.24) did not differ significantly from the comparison group. Cognitive Bias Modification can help Boost Your Mood, Reduce Stress and Break Addiction. Bayes factors analyses revealed that the present pattern of findings does not result from a lack of statistical power. 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). 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.). 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. After that, the ECT and questionnaires were completed. 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. 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. Table 4 shows the significant post hoc contrasts for the analyses of the traditional AB scores as well as of the TL-BS indices. With the advent of attentional bias modification techniques (Mathews & MacLeod, 2002), it became possible to modify attentional bias experimentally. These other measurements are beyond the scope of this study (see [34, 35]for a detailed description). Together, this pattern indicates that the mixed MDD/AD group showed larger AB scores towards shortly presented threat words as well as larger AB scores away from longer presented threat words than the comparison group. Because the NESDA is a naturalistic study, medication use was not under experimental control and analyses were conducted regardless of the use of medication. 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. 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). Together the current pattern of findings regarding the threat trials is consistent with -and complements- previous studies showing that participants with AD are characterized by an AB for disorder-specific threat stimuli . Therefore, the current study included both depression-relevant and threat-related stimuli to test whether participants with a clinically-diagnosed MDD show an AB not only for depression-related stimuli but also for threat-related stimuli. This may reflect a greater dysregulation of attentional processing of emotional information in rMDD individuals . Roles Finally, we hypothesized that the group of participants with co-morbid AD would be characterized by an AB for general threat words, especially when presented for a short duration. Software, One way to test this explanation would be to use both types of stimuli within a single study. Software, rMDD individuals also attended to anxiety-related images (e.g., scenes of threat and injury, people being threatened by weapons) more than never depressed individuals. The attentional bias describes our tendency to focus on certain elements while ignoring others. This topic continues to inspire the development of new tasks and training paradigms that have … The funding was given to the NESDA consortium. Both traditional and trial level (dynamic) AB scores failed to show an AB for negative adjectives in participants with MDD or mixed MDD/AD. The between subject tests indicated that the multivariate effect of group was mainly carried by the AB index of negative adjectives specifically for long duration trials (1250 ms). argued that previous findings concerning AB were explained by a failure to take the importance of the dynamic nature of AB into account. In this way we were able to examine whether the pattern of AB in pure MDD participants differed from that in individuals with comorbid AD. Data curation, See S1 Appendix for the stimulus words per stimulus type. No, Is the Subject Area "Reaction time" applicable to this article? 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. https://doi.org/10.1371/journal.pone.0205154.t005. This attentional bias feeds, reinforces, and prolongs depressive thought patterns, and serves as an underlying risk factor for depressive symptom onset and relapse. Writing – review & editing, Affiliation Attentional disengagement toward sad information was not associated with brooding. Bonferrroni adjustedpost hoc between group tests indicated that for the 1250 ms trials specifically the rMDD group showed a higher (less negative) AB score for negative adjectives than the comparison group without (a history of) MDD/AD (mean difference 9.07 ms (s.e. Only a few studies have looked at AB for threatening information in MDD. Conceptualization, 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. Then during the face-to-face contact the written information was discussed and it was checked whether the information was completely understood. 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.,) are more important in MDD. Method. To test the predicted pattern of stimulus specific AB as a function of group we subjected the traditional AB scores (Negative 500 ms, Negative 1250 ms, Positive 500 ms, Positive 1250 ms, Threat 500 ms, Threat 1250 ms) to a Multivariate Analyses of Variance (MANOVA) with the AB scores as the dependent factor and Group (Comparison, rMDD, MDD, and MDD/AD) as fixed factor. In a similar vein, both dysphoric and rMDD individuals spent significantly less time attending to positive images (such as scenes of people smiling, or kittens) and more to depression-images (e.g., scenes of people appearing sad, unhappy, or images of neglected animals, etc.) In addition, we hypothesized that the group of remitted participants would still have an AB, but less than the clinical groups (participants with MDD with and without ADs). 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… Supervision, Data curation, Although the TL-BS approach showed promising results in terms of prognostic value, it also gave rise to major conceptual criticisms. Writing – review & editing, Affiliation In addition, for both presentation times the mixed MDD/AD group showed more variability in AB scores for general threat words than the comparison group which may be interpreted as further evidence for a heightened sensitivity for threat stimuli (cf. It focuses on possible attentional biases in depression, and whether such biases constitute a cognitive vulnerability factor to suffer from the disorder or, on the contrary, they reflect a feature associated exclusively with the clinical level of depression. were more revealing of attentional bias than were emotional words and scene images . Median scores were computed for the different presentation times and type of trials (valid/invalid), for all stimulus types. This prediction is based on the hypothesis that AB is a stable vulnerability factor that renders individuals vulnerable for the development of depression. Irrespective of its source, it seems plausible to assume that heightened attention for negative adjectives might promote the generation of a negative self-view, thereby lowering the threshold for the recurrence of depression, as described in the cognitive model of Beck [6, 7]. Statistical analyses were run on 96.24% of the data. Methodology, 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. We examined AB for sad and happy materials in three modified versions of the exogenous cueing task using scenes, facial expressions, and words. Trial types (e.g., a positive valid trial with 500 ms presentation time) with 40% errors or more were also excluded. Formal analysis, 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. This attention bias of information processing plays a crucial role in the pathogenesis, maintenance, and development of depression (11, 12). Thus, any differential effect that may be found in the current study should be considered in light of these conceptual criticisms. Writing – original draft, 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. 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 . Of the 2128 participants, we selected four subgroups: Group 1 (MDD) consisted of participants diagnosed with a current (in the last month) MDD, but without dysthymia and without a current AD or history of ADs (n = 29; 1.36%); Group 2 (mixed MDD/AD) consisted of participants diagnosed with a current (in the last month) major depressive disorder and a current anxiety disorder, but without dysthymia (n = 86; 4.04%); Group 3 (rMDD) consisted of participants with a history of MDD, but no current MDD nor dysthymia (in the last six months) and no current or history of anxiety disorders (n = 294; 13.81%); Group 4 (comparisons) consisted of healthy comparisons without a lifetime history of either anxiety or depressive disorders (n = 474; 22.27%) . Attentional bias to negative information has been considered as a vulnerability factor for depression, enhancing susceptibility and maintenance of this disorder. These words scored high on subjective familiarity in an earlier study investigating 740 Dutch words on affective and subjective familiarity . We therefore measured AB both for shorter and longer presentation times. 0.25), p < .01, 95% CI [0.29, 1.65], d = 0.31. Methodology, None of the analyses using the traditional AB indices showed a specific AB in the mixed group, neither for negative nor for positive stimuli. 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. 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. The notion is that by practicing attending to happiness, I recognizing that the tendency to focus on the negative can lead to depression, and deliberately seeking out positive stimuli in the environment, we may be able to treat and/or prevent depression. To test whether differences in AB would be most pronounced when stimuli would be presented for a longer duration as was found in previous analogue research (e.g., ), we also included trials with 1250 ms presentation time. Yes Given the stimulus onset asynchrony used in the current study (500 and 1250 ms), negative cue validity effects were to be expected. For TL-BS Variability Positive 1250 ms, the mean difference between the comparison group and the mixed MDD/AD group was 0.87 (s.e. Yes 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. Conceptualization, Apart from the conceptual criticisms with regard to TL-BS (e.g.,), it is important to note that we measured AB with an ECT instead of a visual probe task (VPT), and used four instead of three categories of stimuli (as[30, 31]). 0.20), p = .75, 95% CI [-0.31; 0.68], d = 0.07) showed significantly higher scores than the comparison group. The lifetime Composite International Diagnostic Interview (CIDI, lifetime version 2.1;) was used to diagnose anxiety (panic disorder with agoraphobia, panic disorder without agoraphobia, agoraphobia without panic disorder, social phobia, generalized anxiety disorder) and depressive disorders according to DSM-IV criteria . The between subject tests indicated that the effect of group was neither significant for variability of AB for Negative 500 ms (F (3,871) = 2.61, p = .05, partial η2 = .009), nor for Negative 1250 ms (F (3,871) = .86, p = .45, partial η2 = .003). However, systematic reviews point to limited efficacy in terms of remission, response rates and long-term effects for both pharmacological  … here. 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). 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). Zvielli et al. A double-blind, placebo-controlled within-subject crossover design was used. 3.20), p = .955, 95% CI [-6.21; 9.10], d = 0.03), differed significantly from the comparison group with regard to the AB treat index. A few additional assessments, e.g. For both short and long presentation times, participants were generally faster on invalid than on valid trials. 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). This has limited the amount of data points to express TL-BS and the number of different trial types tripled, which could both have influenced the reliability and validity of these indices in our 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. However, since most evidence is based on analogue research or small heterogeneous clinical samples (e.g., , it remains important to test the robustness of this pattern in well-defined clinical samples. Citation: Elgersma HJ, Koster EHW, van Tuijl LA, Hoekzema A, Penninx BWJH, Bockting CLH, et al. 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. Is the Subject Area "Depression" applicable to this article? Building further on previous concepts and measurements of AB, these authors proposed trial-level bias scores (TL-BS) representing variance in AB towards the target stimuli, variance in AB away from the target stimuli, maximum AB towards the target stimuli, maximum AB away from the target stimuli, and overall variability in AB towards and away from the target stimuli. e0205154. If a stimulus (a “cue”) precedes the target at the same spatial location, it is called a “valid” trial. An incorrect response was also discarded. No, Is the Subject Area "Sensory cues" applicable to this article? Attentional bias is described as the preferential attention toward certain types of (emotional) information in the environment. Additionally, it is unclear whether comorbid depression modulates abnormal emotional processing in OCD. However, findings concerning the presence of these biases in depression are mixed. https://doi.org/10.1371/journal.pone.0205154.t006. Cues were 16 generally threatening words, 16 neutral words, 16 negative adjectives, and 16 positive adjectives (see Table 1). The anxious and depressed groups showed an attentional bias towards supraliminal negative words, in comparison with normal controls. This pattern indicates that for both presentation times the mixed MDD/AD group showed more variability in AB for general threat words than the comparison group, whereas the rMDD group also showed more variability in AB for general threat words than the comparison group but only for short duration trials (500 ms). For the other indices regarding the neutral stimuli there were no significant between group differences (Neutral Towards 500 ms F (3,734) = 1.27, p = .28, partial η2 = .005; Neutral Away 500 ms F (3,734) = 0.47, p = .69, partial η2 = .002; and Neutral Away 1250 ms F (3,734) = 1.17, p = .31, partial η2 = .005). The study was supported by Accare; institution for children- and adolescent psychiatry. The task used in this study was modelled after the ECT used in previous research on anxiety and depression (e.g., [42, 43, 44]). Attentional bias (AB) for negative stimuli is important in depression onset, maintenance, and remission. We hypothesized that especially for the longer presentation times participants with MDD with and without AD’s would be characterized by stronger AB for negative adjectives than the comparison group. https://doi.org/10.1371/journal.pone.0205154, Editor: Mariska E. Kret, Leiden University, NETHERLANDS, Received: April 14, 2017; Accepted: September 20, 2018; Published: October 31, 2018. See Table 5 for zero-order correlations. For the correct trials and missing pairs in calculating TL-BS per stimulus type per presentation time, see S3 Appendix. Department of Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands, Roles Thus supporting its validity, the ECT was sufficiently sensitive to detect differences in participants’ AB for neutral versus disorder-relevant stimuli. The process of AB might not only be specific for diagnoses but could also play a transdiagnostic role in psychopathology. Yes Obviously, this explanation remains speculative at this stage, and it would require testing whether such AB is indeed related to individuals’ concerns about a recurrent episode when exposed to this type of negative adjectives. It is important for future research to use a longitudinal approach to test whether indeed AB for general threat cues has predictive validity for the development of ADs. , 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). 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. Therefore, the current study distinguished between groups of participants with MDD (and no AD) and participants with MDD and comorbid AD. ; it was found that depression-related sad faces could well induce negative attentional bias in depression patients [1,28], whereas the threat stimuli associated At shorter presentation times of the cues (100–300 ms), faster responding is generally found on validly cued trials compared to invalidly cued trials, a finding that is referred to as the “cue validity” or cue facilitation effect. Video abstract from Dr LeMoult on her recently published paper "Attentional bias training in girls at risk for depression". 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). Part of the participants used medication such as antidepressants (AD). Discover a faster, simpler path to publishing in a high-quality journal. This pattern indicates that for the long presentation time (1250 ms) the mixed MDD/AD group showed less variability than the comparison group on neutral word trials. The centers of these placeholders were located at 7.9 cm from the fixation cross. In the emotional modification of this paradigm, the emotional value of the cue varies (i.e., emotional vs. neutral) which allows investigation of AB for an emotional cue. Resources, There is also evidence that depression is characterized by a lack of attention towards positive information. After this process, participants were asked to sign the consent form. Unexpectedly, also the rMDD group showed more variability than the comparison group with a mean difference of 0.35 (s.e. 0.22), p = .006, 95% CI [0.16; 1.25], d = 0.36). Overall, the researchers found that anxious individuals were significantly slower to respond to the target image when the distracting images were negative as opposed to when they were positive or neutral. 0.25), p < .01, 95% CI [0.27; 1.49], d = 0.38. Against predictions, there was no specific AB in the group of MDD, neither for negative nor for positive adjectives. We used this same method to match each valid trial to a subsequently presented invalid trial. Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands, In this way, we computed time series of TL-BS per participant. 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. Neither the association between AB toward negative information and brooding nor the one between AB away from positive stimuli and anhedonia was significant. Competing interests: The authors have declared that no competing interests exist. Cues were presented at random on the right or left side of the fixation cross and every word cue was presented twice in each half of the task: Once in a valid trial (i.e., word cue is valid predictor for the target location), and once in an invalid trial. The fourth aim of this study was to investigate AB in remitted depressed (rMDD) participants. Based on this view, Zvielli, et al. We computed an AB score for negative, threat, and positive words per presentation time. The current findings provide preliminary evidence indicating that individuals who were remitted from MDD show an AB for negative adjectives and seem more sensitive for general threat stimuli. Attentional bias and depression Attentional bias encompasses the rapid allocation and delayed disengagement of attention to salient visual stimuli. No, Is the Subject Area "Attention" applicable to this article? These clinical groups were contrasted with participants without a history of MDD or ADs. An important next step would be to use a longitudinal design to test whether indeed heightened AB in rMDD individuals is predictive of relapse. This study used data from the baseline and 2-year follow-up assessment (for details see and the website www.nesda.nl) as the latter was the wave in which the ECT assessment was incorporated. If a participant gave the wrong number, also a rectangle with the words “missed digit!” in capitals appeared in the middle of the screen. 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. https://doi.org/10.1371/journal.pone.0205154.s001, https://doi.org/10.1371/journal.pone.0205154.s002, https://doi.org/10.1371/journal.pone.0205154.s003, https://doi.org/10.1371/journal.pone.0205154.s004. We compared three groups based on a semi-structured diagnostic interview and a depressive symptoms scale (BDI-II): 34 individuals with major depressive disorder (clinically depressed); 35 with a dysphoric mood but without the criteria of major depressive disorder (i.e., subclinically depressed), and 26 never been depressed individuals. Addressing these issues is the main aim of this study as described next in more detail. Neither the MDD group (mean difference = -0.22 (s.e. Writing – review & editing, Affiliation Copyright: © 2018 Elgersma et al. There was a non-significant trend for AB Threat 500 ms (F (3, 853) = 2.32, p = .07, partial η2 = .008). We thank Martine Ruiter for her helpful ideas and for her assistance in the initial process of data-reduction and especially Prof. M.S. Stroke is more likely in older adults, who can have reduced cognitive function. For TL-BS Variability Threat 500 ms the mixed MDD/AD group showed significantly more variability than the comparison group with a mean difference of 0.88 (s.e. The relatively slow reaction times on validly cued trials indicate an inhibition of return effect. Keywords: Attentional bias modification, Depression, Clinical trial Background A wide range of treatments are available for depression. This study aims to investigate the acute and chronic effects of a dietary intervention of 22 g freeze-dried whole wild blueberry powder. This study investigated depression-related AB within the context of a large scale nationwide study on depression and anxiety, which allowed us to select rigorously-defined clinical groups. Participants received written study information at home to read before they were invited to the face-to-face interview. The study was supported by ZonMw (OOG) (Grant 100000–2035). 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. Our results raise questions about how common AB is in depression. This is consistent with the view that threat bias is a premorbid characteristic that heightens the risk for the development of ADs, although it may also reflect a symptom of AD or the relatively high severity of the mixed group’s condition. The MANOVA showed a significant intercept (Wilks’ λ = .95, F (6, 848) = 6.70, p < .001, partial η2 = .04) indicating that overall the AB scores differed from zero. Yes We replaced these outliers with the group mean for that index plus (or minus) 3 SDs. Although, the overall pattern as a function of group was quite similar for both types of indices there were also some notable exceptions: The AB for negative stimuli in rMDD that was only evident for the traditional index whereas the AB away from positive stimuli in the mixed group and the biases for threat stimuli were only evident for the TL-BS. We deliberately choose to select participants with MDD and without dysthymia, allowing to specifically test AB in MDD per se. In these trials, instead of a word cue, a digit appeared for 100 ms at the location of the fixation cross. For more information about PLOS Subject Areas, click Importantly, previously depressed individuals spent more time looking at anxiety-relevant images during a free-viewing task (such as scenes of people being threatened with weapons, people with physical injuries, dangerous situations) than never depressed individuals . 0.23), p < .001, 95% CI [0.26, 1.48], d = 0.44 (see also Table 4). 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. Baseline assessments started in September 2004. Whether Obsessive Compulsive Disorder (OCD) is associated with an increased attentional bias to emotive stimuli remains controversial. 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.
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