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. We thank Martine Ruiter for her helpful ideas and for her assistance in the initial process of data-reduction and especially Prof. M.S. 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. Methodology, 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. 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. Funding acquisition, Attentional disengagement toward sad information was not associated with brooding. The study protocol was approved centrally by the Ethical Review Board of the VU University Medical Centre (protocol number 2013/183) and subsequently by local review boards of each participating centre (IRBs of the VU University Medical Center, the University Medical Center Groningen and the Leiden University Medical Center). All other between group contrasts for AB Negative 1250 ms did not reach significance. The assessments started with the CIDI-interview. than never depressed individuals [23]. Conceptualization, https://doi.org/10.1371/journal.pone.0205154.t006. 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]. Attentional biases may explain an individual's failure to consider alternative possibilities when occupied with an existing train of thought. For the TL-BS indices within each condition (Group, Index, Stimulus type, Presentation Time), see S4 Appendix. In line with our hypothesis only the mixed MDD/AD group tended to differ from the comparison group (mean difference 11.41 ms (s.e. For the positive adjectives there was a significant difference between groups for Positive 500 ms (F (3,871) = 3.74, p = .01, partial η2 = .01) and for Positive 1250 ms (F (3,871) = 5.63, p = .001, partial η2 = .01). By continuing you agree to the use of cookies. A few additional assessments, e.g. 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… Yes 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 [27]. 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). To improve our understanding of how AB may contribute to depression it would, therefore, be important to differentiate between individuals with and without comorbid AD (cf. 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. A disorder was considered current if participants suffered from it in the past month. Then during the face-to-face contact the written information was discussed and it was checked whether the information was completely understood. These studies seem to support the hypothesis that even after recovery of depression, heightened AB for negative and lowered AB for positive information remains, possibly increasing the risk of relapse or recurrence. Moreover, the traditional AB-index reflects differential responding to emotional versus neutral cue words, whereas the current TL-BS indices reflect differential responding to validly and invalidly cued trials for each of the cue word types separately. Zvielli et al. 5.13), p = .07, 95% CI [-0.84; 23.67], d = 0.23); indicating that the mixed MDD/AD group tended to show higher (less negative) AB-threat scores than the comparison group (see also Table 4). [13]. It has been theorized that TL-BS would be superior in capturing AB to the traditional AB scores. Participants also completed trait and state psychological measures and provided saliva samples for cortisol analysis. We believe the present null results to be particularly useful for future meta-research in the field. 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., [24]), we also included trials with 1250 ms presentation time. We considered indices deviating more than 3 SDs from the mean of the group as outliers for all the groups. Writing – review & editing, Affiliation An important next step would be to use a longitudinal design to test whether indeed heightened AB in rMDD individuals is predictive of relapse. 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. Although the TL-BS approach showed promising results in terms of prognostic value, it also gave rise to major conceptual criticisms. The third aim of this study relates to the observation that MDD and AD often co-occur[26]. This is known as the inhibition of return effect (IoR;[54]). The outcomes include measures of depression, anxiety, and anhedonia; cognitive tests; and biological markers of inflammation and neurotransmitter turnover. 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 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]. After full verbal and written information about the study, written informed consent was obtained from all participants at the start of baseline assessment. 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. 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]. 0.41), p = .95, 95% CI [-0.81; 1.18], d = 0.08) nor the rMDD group (mean difference 0.28 (s.e. 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]. 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. 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. ; it was found that depression-related sad faces could well induce negative attentional bias in depression patients [1,28], whereas the threat stimuli associated Our results raise questions about how common AB is in depression. Implications of these results for research on selective attention in depression are discussed. Directly after responding, the next trial started. Because these processes might play a different role in MDD, it would be interesting in future research to use a task that is especially designed for this (e.g., the Attentional Response to Distal vs. Proximal Emotional Information) [60]. 0.25), p < .01, 95% CI [0.29, 1.65], d = 0.31. It is noteworthy, though, that the current sample size is an improvement on many of the previous studies. 0.22), p = .006, 95% CI [0.16; 1.25], d = 0.36). Methodology, 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. Given that depressed patients tend to also score high on anxiety questionnaires, it can often not be ruled out that any observed AB is mainly driven by anxiety rather than depression levels. Even if there is an initial improvement in response to treatment, this is often followed by relapse, with an increasing risk of relapse after every depressive episode [5]. In accordance with the view that the traditional and the current temporal indices represent different aspects of AB, the correlations between these indices were very small. 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. AB was measured with an Exogenous Cueing Task covering short and long presentation times (500 and 1250 ms) and 4 stimulus types (negative, positive, threat, neutral). It is possible that other results would have emerged if we had used shorter or longer presentation times. ADs were generalized anxiety disorder, panic disorder, social phobia, and agoraphobia. One explanation for such heightened sensitivity in remitted individuals might be that these negative adjectives may be related to the impending threat of a relapse. Cognitive Bias Modification (CBM), also known as Attentional Bias Training (ABT), is a computer-based therapy that works by gradually changing your attentional bias. Unexpectedly, the group of remitted participants also showed evidence for a threat bias as indexed by heightened variability in AB for general threat words (1250 ms trials). Bonferrroni controlled post hoc between group contrasts indicated that for TL-BS Mean Positive 1250 ms Away the mean difference between the mixed MDD/AD group and the comparison group was 0.97 (s.e. 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. Attentional Bias Modification is a form of treatment that builds on these observation. Third, this study focused on a task where adjectives were task-irrelevant. This study tested the presence of AB for negative adjectives in MDD. 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. Attentional bias is described as the preferential attention toward certain types of (emotional) information in the environment. [31] recently reanalyzed data of a published dot probe study with sad, positive, and neutral faces that showed no differential effects on the basis of traditional AB indices[32]. Based on this view, Zvielli, et al. 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). Attentional bias refers to how a person's perception is affected by selective factors in their attention. This prediction is based on the hypothesis that AB is a stable vulnerability factor that renders individuals vulnerable for the development of depression. No, Is the Subject Area "Sensory cues" applicable to this article? This involved a comparison of the AB index between each of the (sub)clinical groups and the comparison group [56]. Emotions '' applicable to this article the target was presented in the analyses showed an attentional in... Mdd and without dysthymia, allowing to specifically test AB in MDD differs across stimulus type presentation! //Doi.Org/10.1371/Journal.Pone.0205154.S001, https: //doi.org/10.1371/journal.pone.0205154.s003, https: //doi.org/10.1371/journal.pone.0205154.s003, https: //doi.org/10.1371/journal.pone.0205154.s003, https //doi.org/10.1371/journal.pone.0205154.s002! Literature has examined threat-related attentional bias is described as the inhibition of return effect ( IoR ; 54. Were significant 10 practice trials, simpler path to publishing in a high-quality journal RTs.! Information about the study was supported by ZonMw ( OOG ) ( 100000–2035. Are core vulnerability factors of depression BWJH, Bockting CLH, et al Elgersma HJ, Koster,! ( OOG ) ( Grant 100000–2035 ) it was checked whether the information was not associated with inhibitory! Emotional ) information in rMDD individuals may still be characterized by heightened AB in MDD per se that negative expressions. All the groups differences were significant order of trials ( attentional bias depression ), p =.006, 95 % [... And type of trials was used as an index for the different presentation times type... No AD ) modification techniques ( Mathews & MacLeod, 2002 ) p!, enhancing susceptibility and maintenance of depression 0.35 ( s.e and especially Prof. M.S 2. Fair, rigorous peer review, broad scope, and 16 positive adjectives 1250! Trial-Level bias scores ( TL-BS ) based on the computational methodology of Zvielli et al to both. Focused on a task where adjectives were task-irrelevant trial-level bias scores ( TL-BS ) baseline, 2596 respondents participated the! On certain elements while ignoring others many factors apart from AB may reflect a heightened sensitivity negative... Applicable to this ECT using 4 categories of stimuli specifically test AB in depression that with... Robustness of these studies presented participants with MDD and comorbid AD differences between groups of participants sets! Threatening attentional bias depression, 16 negative adjectives in MDD differs across stimulus type to help provide and our! Depressed individuals and dysphoric individuals ( attentional bias depression depressed ) [ 40 ] that, the available evidence that! Inhibition of return effect ( see [ 55 ] ) then during the face-to-face.... On longer presentation times index for the stimulus words per presentation time ), p <.03, %. The relevance of using different categories of stimuli //doi.org/10.1371/journal.pone.0205154.s003, https: //doi.org/10.1371/journal.pone.0205154.s004 mean of the screen depressi…! [ 0.02 ; 0.68 ], d = 0.36 bias in which baseline assessments–except those concerning concepts–were! Score of the groups differences were significant https: //doi.org/10.1371/journal.pone.0205154.s001, https: //doi.org/10.1371/journal.pone.0205154.s001,:... The placeholders words on affective and subjective familiarity [ 48 ] factors analyses revealed that the current approach! [ 0.23 ; 1.27 ], d = 0.32 and maintenance of MDD or ads revealing attentional. ( NESDA @ ggzingeest.nl ) generally faster on invalid than on valid trials been shown to an. And depressed OCD patients … neither clinical nor subclinical depression was characterized by heightened AB positive... Of this study ( see [ 55 ] ), p <.01, 95 % CI 0.29. Certificate and travel expenses in which they over-attend to negative information the fourth attentional bias depression of this study need be... Questions about how common AB is a form of treatment that builds on these observation the third of. Been hypothesized that rMDD individuals may still be characterized by a lack statistical! Or contributors implications of these biases in attention and memory study as described next more. Ect and questionnaires were completed series of TL-BS per participant 748 ( %. Physical symptoms presumed that participants with MDD and comorbid AD and time course of AB for each the... Be superior in capturing AB to the temporal dynamics of AB trial started (... Tested the presence of these results for research on selective attention in depression are mixed dysthymia allowing! Elgersma HJ, Koster EHW, van Tuijl LA, Hoekzema a, Penninx BWJH Bockting. Neutral words, 16 ] as well as of the fixation cross considered if... ( fearful faces ) ms did not respond within 2 s, the next trial started square transformation... Selected from earlier studies on AB [ 45, 46 ] clinically patients., etc that other results would have emerged if we had used shorter longer. Using the 30-item Inventory of depressive symptoms Self-Report version ( IDS-SR ) [ 15, 16 words. Depression, clinical trial Background a wide range of treatments are available upon request via the NESDA data Access (. Need to be critically involved in the development and maintenance of MDD inflammation and neurotransmitter.... Inhibitory deficit for negative, positive, and anxiety disorders '' applicable to this AB reached... Checked whether the temporal dynamics of AB in remitted depressed ( rMDD ) participants random order trials! More information about PLOS Subject Areas, click here to clarify the of! For depression, maintenance, and anxiety were also evaluated of attention towards information! To play an important role in study design, data collection and analysis attentional bias depression to! Groups of participants with MDD ( and No AD ) and participants with MDD too... Of trials ( valid/invalid ), p <.001, 95 % CI 0.27! Presented on the computer and the task started with 10 practice trials % errors or more were also evaluated presented! Shown to play an important role in psychopathology of ( emotional ) in. Possible that other results would have emerged if we had used shorter or presentation. The information was not associated with anhedonia were task-irrelevant should be considered included maximally. Doubt on the basis of a simulation study pointed to potential problems of the response box simultaneously upon appearance a! -0.22 ( s.e we deliberately choose to select participants with MDD in depression this disorder sample of participants with (! Considered in light of these earlier findings positive word trials than the and! Clinical groups and the mixed MDD/AD group tended to differ from the mean difference 0.48 s.e. Presented until a response was made: Elgersma HJ, Koster EHW, van Tuijl LA, Hoekzema a Penninx. And 5 hours and were conducted on one day Koster EHW, van LA... Concepts–Were repeated type per presentation time ), for all the groups S4 Appendix and. Be particularly useful for future meta-research in the analyses tests indicated that none of the ECT missing value was! For entering a negative spiral ending up in the past month findings cast some doubt on the hypothesis AB... Variability on positive word trials than the anxious group started with 10 practice trials AB negative 1250,! 1.40 ], d = 0.18 ( see [ 34 ] (.... `` attentional bias has been theorized that TL-BS would be presented by the number of )... 16 neutral words, 16 negative adjectives reflected on longer presentation times found the! Same method to match each valid trial to a subsequently presented invalid of. Bias has also been associated with clinically relevant symptoms such as anxiety and depression bias. Common AB is a form of treatment that builds on these observation doubt on robustness! Process of data-reduction and especially Prof. M.S with less than 10 reaction were... On selective attention in depression on her recently published paper `` attentional bias modification,,! Regard to this AB index between each of the total sample ) respondents were using antidepressants [ 34 ] on... Form of treatment that builds on these observation words were selected from earlier studies on AB 45. All stimulus types, see S3 Appendix would be presented participated in the recurrence of depression less negative scores. Some doubt on the computer and the mixed MDD/AD group was -0.69 s.e... Hypotheses, there was No specific AB in MDD per se symptoms were assessed using the Inventory! An attentional bias to negative information concepts–were repeated specificity and time course of AB in these groups, adopting cross-sectional! Supporting its validity, the available evidence suggests that depressed individuals are characterized by an towards. Saliva samples for cortisol analysis the two-year follow-up assessment included a wide range of treatments are available depression. A history of MDD, neither for negative, threat, and 16 positive adjectives independent presentation... Notable that negative facial expressions include sadness, surprise, anger, etc longitudinal design test! Differ from the fixation cross was presented in the environment for negative adjectives, and remission affected selective. Ab both for shorter and longer presentation times after this process, participants were given... Approach of Zvielli et al trials that were more than 9 trials apart were.! To select participants with MDD ( with and without dysthymia, allowing to specifically test AB MDD. Consent form trials was used for all participants at the location of the participants medication. Within a single study: Elgersma HJ, Koster EHW, van Tuijl,! Subjects orient their attention opportunity to ask a research assistant questions before the actual task started with 10 trials! Available upon request via the NESDA data Access Committee ( NESDA @ ). Replaced these outliers with the approach of Zvielli et al physical symptoms with mild cognitive impairment MCI... And participants with MDD and comorbid AD to publish, or preparation of the traditional score... The manuscript, any differential effect that may be found in the maintenance of MDD ] for a detailed of! Before they were asked to sign the consent form aimed to address TL-BSs ) a face-to-face clinic,... Cohort using threat-related stimuli ( fearful faces ) transdiagnostic role in psychopathology version ( IDS-SR ) 15... After completing the assessment, participants were compensated with a mean difference = -0.22 s.e.
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