Cues (words) and targets (black squares) were presented in the center of the placeholders. Because indices were positively skewed, variables were subjected to a square root transformation, before being used in the analyses. The heightened AB scores for threat stimuli in the mixed group could well be the result of the comorbid AD (e.g., driven by AD-related fearful preoccupations), although it cannot be ruled out that the presence of the threat bias is related to the more severe condition of the mixed group compared to the pure MDD group. 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]. The obtained results are in line with the hypothesis that depression is associated with an inhibitory deficit for negative information. 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. 0.37), p = .29, 95% CI [-.29; 1.49], d = 0.29) nor the rMDD group (mean difference 0.20 (s.e. Project administration, We assumed that both patterns would especially be reflected on longer presentation times. 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 study was supported by ZonMw (OOG) (Grant 100000–2035). Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom, Roles Table 4 shows the significant post hoc contrasts for the analyses of the traditional AB scores as well as of the TL-BS indices. [31]). 0.16), p = .21, 95% CI [-0.27; 1.49], d = 0.13) showed significantly stronger variability than the comparison group. 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. It has been theorized that TL-BS would be superior in capturing AB to the traditional AB scores. Yes No, Is the Subject Area "Anxiety disorders" applicable to this article? The MANOVA showed a significant multivariate effect of group (Wilks’ λ = .95, F (24, 2506) = 1.82, p < .01, partial η2 = .01. The lifetime Composite International Diagnostic Interview (CIDI, lifetime version 2.1;[38]) 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 [39]. Implications of these results for research on selective attention in depression are discussed. Below we discuss these findings in relation to the key issues that this study aimed to address. 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. A few additional assessments, e.g. A similar pattern has been found in dysphoric individuals (sub-clinically depressed) [15, 16]. 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]. After this process, participants were asked to sign the consent form. 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. Taken together, the available evidence suggests that depressed individuals are characterized by heightened AB for negative information and lowered AB for positive information. This was true for both AB quantified by traditional AB indices, and AB quantified by trial-level bias scores (TL-BS). The main results using traditional AB scores were: (i) compared to those without a history of MDD or AD, there was no evidence for a difference in AB towards negative adjectives or away from positive adjectives in strictly defined clinical groups of MDD participants with or without a comorbid AD; (ii) specifically for longer duration trials (1250 ms), rMDD individuals showed higher (less negative) AB scores for negative adjectives than the no AD/MDD comparison group. Methodology, In the original exogenous cueing paradigm [41], participants are asked to detect a visual target presented at a left or right peripheral location. PLoS ONE 13(10): Yes Participants were then given the opportunity to ask a research assistant questions before the actual task started. After full verbal and written information about the study, written informed consent was obtained from all participants at the start of baseline assessment. Attentional bias in anxiety and depression has been studied extensively with a variety of attentional tasks. According to prominent cognitive models of depression, selective attentional biases to mood-congruent information are key vulnerability factors that contribute to maintaining the disorder [5,6]. Conceptualization, The mixed MDD/AD group showed a higher trial-level AB score away from positive adjectives (1250 ms) than the comparisons. 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. Supervision, For the TL-BS indices within each condition (Group, Index, Stimulus type, Presentation Time), see S4 Appendix. (2018) Attentional bias for negative, positive, and threat words in current and remitted depression. 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 anxious and depressed groups showed an attentional bias towards supraliminal negative words, in comparison with normal controls. 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. https://doi.org/10.1371/journal.pone.0205154.t001. Many of these cognitive models include attentional bias (AB) as both a contributing and a maintaining factor to depression (e.g.,[11]. However, systematic reviews point to limited efficacy in terms of remission, response rates and long-term effects for both pharmacological [1] … For more information about PLOS Subject Areas, click In contrast to our hypotheses, there were no ABs for negative or positive information, regardless of the task and the groups. 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%) [35]. ; it was found that depression-related sad faces could well induce negative attentional bias in depression patients [1,28], whereas the threat stimuli associated During each trial, a white fixation cross was presented in the center of the screen. Fourth, some of the observed effects had a small effect size and might not easily replicate in smaller samples and some of the groups were relatively small, which implied that for some between group contrasts (e.g., MDD vs. comparison) the statistical power was insufficient to reliably detect differences in AB with moderate or small effect sizes. The difference between groups for Neutral 500 ms just fell short of significance (F (3,871) = 2.53, p = .05, partial η2 = .009). © 2020 The Author(s). Second, we used 500 ms presentation times, as the majority of previous VPT studies used this presentation time thereby guaranteeing optimal comparison with these earlier studies. 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 [23]. 0.22), p = .006, 95% CI [0.16; 1.25], d = 0.36). 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]. Relatively strong cue validity effects and relatively weak IoR (and thus more positive or less negative AB scores) are interpreted as attention bias toward a particular stimulus type, whereas relatively weak cue validity effects and strong IoR (and thus less positive or more negative AB scores) are considered to reflect a bias away from particular stimuli. https://doi.org/10.1371/journal.pone.0205154.t006. 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. It is possible that other results would have emerged if we had used shorter or longer presentation times. [30] did (sum of all distances between sequential TL-BSs divided by the number of TL-BSs). 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]. We believe the present null results to be particularly useful for future meta-research in the field. Funding acquisition, 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). Directly after responding, the next trial started. 0.20), p = .75, 95% CI [-0.31; 0.68], d = 0.07) showed significantly higher scores than the comparison group. This pattern indicates that for both presentation times the mixed MDD/AD group showed more variability on positive word trials than the comparison group. 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. Whether Obsessive Compulsive Disorder (OCD) is associated with an increased attentional bias to emotive stimuli remains controversial. https://doi.org/10.1371/journal.pone.0205154.t005. Methodology, 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. Of the 2981 participants who were included at baseline, 2596 respondents participated in the 2-year follow-up measurements. This study aims to investigate the acute and chronic effects of a dietary intervention of 22 g freeze-dried whole wild blueberry powder. Such heightened sensitivity for negative stimuli might well lower the threshold for entering a negative spiral ending up in the recurrence of depression. 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). In line with previous studies (e.g., [24]), RT’s < 200 ms and RT’s > 1000 ms were considered anticipatory responding and delayed responding, respectively, and were discarded. Brooding, anhedonia, and anxiety were also evaluated. We replaced these outliers with the group mean for that index plus (or minus) 3 SDs. 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. This is known as the inhibition of return effect (IoR;[54]). 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. Against predictions, there was no specific AB in the group of MDD, neither for negative nor for positive adjectives. The attentional bias describes our tendency to focus on certain elements while ignoring others. Although the TL-BS approach showed promising results in terms of prognostic value, it also gave rise to major conceptual criticisms. 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). Earlier research provided evidence indicating that it may be critical to take the time course of AB into consideration when examining the relevance of AB in the context of depression. Conceptualization, [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]. Cognitive Bias Modification (CBM), also known as Attentional Bias Training (ABT), is a computer-based therapy that works by gradually changing your attentional bias. This attention bias of information processing plays a crucial role in the pathogenesis, maintenance, and development of depression (11, 12). 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. Cues were 16 generally threatening words, 16 neutral words, 16 negative adjectives, and 16 positive adjectives (see Table 1). 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 [53]. Visualization, 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. 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. 0.25), p < .01, 95% CI [0.29, 1.65], d = 0.31. PLOS ONE promises fair, rigorous peer review, 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. Roles Although there is evidence that attentional biases can be responsive to medications in nonclinical populations (e.g., [36], it has been argued that within the context of clinical populations differences in AB are due to improved clinical status rather than to a medical treatment effect per se [37]. The aims of attentional bias modification is to reduce anxiety by attenuating bias towards threatening information. Both biases may reflect a heightened sensitivity for signals related to the impending threat of a new upcoming depressive episode among those who are currently remitted from MDD. The current findings cast some doubt on the robustness of these earlier findings. Together, these findings point to the relevance of using different categories of emotionally relevant stimuli to examine AB in depression. The instructions were presented on the computer and the task started with 10 practice trials. However, findings concerning the presence of these biases in depression are mixed. This attentional bias feeds, reinforces, and prolongs depressive thought patterns, and serves as an underlying risk factor for depressive symptom onset and relapse. Furthermore, attentional bias has been shown to play an important role in the development and maintenance of depressive and anxiety disorders. We computed an AB score for negative, threat, and positive words per presentation time. ... Attentional Bias Medicine & Life Sciences. 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. We computed trial-level bias scores (TL-BS) based on the computational methodology of Zvielli et al. Published by Elsevier Inc. https://doi.org/10.1016/j.comppsych.2020.152173. Negative attentional bias in depression — the tendency of depressed individuals to focus on negative stimuli and thoughts more than healthy individuals — has been the subject of research spanning multiple decades, much of it seeking to explain why the bias is not always observed [1, 2, 3]. This attention bias of information processing plays a crucial role in the pathogenesis, maintenance, and development of depression (11, 12). Investigation, 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). Zvielli et al. Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium, Roles Research has shown that many different factors can bias our attention, from external events and stimuli (such as a perceived threat to our safety) to internal states (such as hunger or sadness). If a participant gave the wrong number, also a rectangle with the words “missed digit!” in capitals appeared in the middle of the screen. (2007) found evidence of threat-related attentional bias in anxiety in reaction time-based studies using the Stroop task ( Stroop, 1935 ) and the visual probe task ( MacLeod et al., 1986 ), but not the spatial cueing task ( Posner, 1980 ). In line with this view, both currently depressed and rMDD individuals selectively attended to sad faces when measured with a dot-probe task [29], whereas healthy comparisons avoided sad faces and oriented toward the happy faces. Furthermore, the total sample of participants with MDD was too small to reliably examine sex differences in AB. 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. 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. The 2-year follow-up assessment included a wide range of outcome measures. The depressed group unexpectedly showed greater vigilance for supraliminal anxiety‐relevant words than the anxious group. At baseline, a total of 748 (25.1% of the total sample) respondents were using antidepressants [34]. Post hoc Bonferroni adjusted between group tests indicated that none of the between group differences with regard to this AB index reached significance. Within the current ECT there were differential lags between the various TL-BSs rendering it problematic to calculate TL-BS Variability in exactly the same way as Zvielli et al. The threatening and neutral words were selected from earlier studies on AB [45, 46]. Funding acquisition, In the current emotional modification of this paradigm, the emotional value of the cue is varied (i.e., emotional vs. neutral) which allows to investigate AB for disorder-relevant emotional information (with the responses to the neutral trials as the reference category and the comparison control participants as the reference group). In line with the approach of Zvielli et al. The assessments started with the CIDI-interview. Therefore, more positive AB scores (i.e., stronger cue validity effects) were indicative of a stronger attentional bias towards the emotional information. 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. Table 6 gives a detailed description of the TL-BS indices Mean and Variability scores per stimulus type and presentation time. Both traditional and trial level (dynamic) AB scores failed to show an AB for negative adjectives in participants with MDD or mixed MDD/AD. It has been hypothesized that rMDD individuals may still be characterized by an AB towards negative and away from positive stimuli. All other mean differences between groups were not statistically significant. For example, cigarette smokers have been shown to possess an attentional bias for smoking-related cues around them, due to their brain's altered reward sensitivity. Researchers have found that people who have eating disorders tend to pay more attention to stimuli related to food, while individuals experiencing drug addictions tend to be hypersensitive to drug-related cues.1 For people struggling to recover from an eating disorder or addiction, this tendency to pay attention to certain signals while discounting others c… The total score of the IDS-SR was used as an index for the severity of depression. This prediction is based on the hypothesis that AB is a stable vulnerability factor that renders individuals vulnerable for the development of depression. Bayes factors analyses revealed that the present pattern of findings does not result from a lack of statistical power. Formal analysis, The current study also failed to corroborate the findings of an earlier small-scale visual probe study (using 500 ms presentation time) among individuals with dysthymia (n = 13) or MDD (n = 7) indicating that these participants were characterized by a vigilance for adjectives that were very similar to the ones used in the current study (e.g., inadequate, useless, stupid, inept) [19]. After that, the ECT and questionnaires were completed. Part of the participants used medication such as antidepressants (AD). A white rectangle placeholder was presented (4 cm high x 10.5 cm long), both on the left and the right side of this fixation cross. Recurrence of depression indices mean and Variability scores per stimulus type and attentional bias depression time factors analyses revealed that the null... Hoc tests tests indicated that none of the ECT and questionnaires were completed for. 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