Mapping Dynamic Interactions Among Cognitive Biases in Depression

Abstract

Depression is theorized to be caused in part by biased cognitive processing of emotional information. Yet, prior research has adopted a reductionist approach that does not characterize how biases in cognitive processes such as attention and memory work together to confer risk for this complex multifactorial disorder. Grounded in affective and cognitive science, we highlight four mechanisms to understand how attention biases, working memory difficulties, and long-term memory biases interact and contribute to depression. We review evidence for each mechanism and highlight time- and context-dependent dynamics. We outline methodological considerations and recommendations for research in this area. We conclude with directions to advance the understanding of depression risk, cognitive training interventions, and transdiagnostic properties of cognitive biases and their interactions.

Inflexible Interpretations of Ambiguous Social Situations: A Novel Predictor of Suicidal Ideation and the Beliefs That Inspire It

“…The central role beliefs play in these prominent accounts of suicidal ideation is notable because beliefs often systematically deviate from reality because of biases in information processing (e.g., confirmation bias; Nickerson, 1998). This is particularly true in the context of psychopathologies (e.g., depression; see Everaert, Bernstein, et al, 2020;Everaert et al, 2017) that frequently feature suicidal ideation (Vuorilehto et al, 2014). Unsurprisingly, then, research indicates that beliefs that might inspire suicidal ideation are not always congruent with reality.…”

Inferences Training Affects Memory, Rumination, and Mood

“…This interplay between inferences and memory retrieval may be seen as an example of the negative vicious cycle that characterizes the experience of depression. Although dynamic interactions among biases in attention, interpretation, and memory have been described as contributing to depression (Everaert et al, 2020), negative inferences have been typically examined in isolation.…”

Dynamics of Internal Attention and Internally-Directed Cognition: The Attention-to-Thoughts (A2T) Model

“…In attentional terms, this means that crisis-related thoughts (representations) are selected into WM and awareness, and selection history to such representation begins to form or "accumulate" (Theeuwes, 2019). Internal selection history may bias continued and ongoing internal selection to related thoughts and memories of the crisis (Ehring & Watkins, 2008) thereby maintaining internally-directed cognition (e.g., negative repetitive thinking) (Everaert, Bernstein, Joormann, & Koster, 2020). Table 1.…”

“…Common forms of maladaptive internally-directed cognition include negative thinking, rumination and worry (Borkovec, Robinson, Pruzinsky, & DePree, 1983;Ehring & Behar, n.d.;Ehring & Watkins, 2008;Nolen-Hoeksema & Morrow, 1991), emotion (dys)regulation (Sheppes, Suri, & Gross, 2015), cognitive fusion and reactivity (Bernstein et al, 2015), cognitive biases such as interpretation bias (Everaert et al, 2020;Everaert, Duyck, & Koster, 2014) and impairments in cognitive control secondary to negative emotional information in working memory (Grahek, Everaert, Krebs, & Koster, 2018;Joormann & Gotlib, 2008) or dyscontrol over episodic memory (Engen & Anderson, 2018;Hitchcock, Golden, Werner-Seidler, Kuyken, & Dalgleish, 2018). These forms of maladaptive higher-level cognition are characteristically internal (focus on thought content and thinking styles), temporal (how thought content and style is expressed over time), affective (how thoughts invoke affect and vice-versa) and selective (e.g., why only specific content becomes repetitive or difficult to disengage from) (Fox et al, 2018;Harvey, Watkins, & Mansell, 2004;Koster, De Lissnyder, Derakshan, & De Raedt, 2011;Nolen-Hoeksema et al, 2008;Siemer, 2005).…”

“…repetitive negative thinking; (Everaert et al, 2020;Hirsch et al, 2018)). Accordingly, interpretation bias is a primary target for many psychological treatments for depression and anxiety as well as emerging cognitive training methodologies (Everaert, Podina, & Koster, 2017;Hirsch et al, 2018).…”