The combined cognitive bias hypothesis in depression

Abstract

Drawing from substantial evidence demonstrating cognitive biases in depression at various stages of information processing (i.e., attention, interpretation, memory, cognitive control), we argue for an approach that considers the interplay among these processes. This paper attempts to apply the combined cognitive bias hypothesis (Hirsch, Mathews, & Clark, 2006) to depression research and reviews competing theoretical frameworks that have guided research in this area. We draw on current findings from behavioral studies on the interplay between depression-related processing biases. These data indicate that various cognitive biases are associated. However, it is not clear whether single or multiple biases are most predictive of depressive symptoms. We conclude this article with theoretical and clinical implications of the current state of research in this field and propose a number of ways in which research on the combined cognitive bias hypothesis can be advanced. A State-of-the-art Major depression is a prevalent psychiatric disorder that is associated with debilitating symptomatic suffering, functional impairments, and high societal costs (Kessler & Wang, 2009). Notwithstanding a range of well-established psychological and pharmacological interventions, relapse and recurrence rates of depression remain high (Vittengl, Clark, Dunn, & Jarrett, 2007) indicating that current therapies do not sufficiently address vulnerability factors for this burdensome disorder. Moreover, with each successive depressive episode the risk for recurrence increases (Boland & Keller, 2009), which points to an expanding vulnerability with multiple episodes. Hence, profound insight into the mechanisms involved in the etiology and maintenance of major depression seems essential in improving contemporary treatment options and the prevention of depression.In the past three decades, research inspired by cognitive accounts of depression has been successful in identifying vulnerability factors for this disorder. Apart from substantial research examining depressive cognitive content as a vulnerability factor (e.g., negative thoughts), a promising line of research highlights the role of cognitive biases in the development, maintenance, and relapse/recurrence of depression (for reviews see Mathews & MacLeod, 2005). Research efforts in this particular area of interest have typically focused on abnormalities in attention, interpretation, and memory processes, which are considered to be instrumental in the understanding of the processes involved in these cognitive biases. More recently, there is growing interest into cognitive and neural mechanisms underlying cognitive control impairments, which may operate across a variety of cognitive biases. Indeed a substantial number of studies on emotional information processing in depressed samples provide evidence that depression is characterized by attention, interpretation, and memory biases, especially for negative information (see below). COMBINED COGNITIVE BIAS HYPOTHESIS IN DEPRESSION 4This resea...

Attention, interpretation, and memory biases in subclinical depression: A proof-of-principle test of the combined cognitive biases hypothesis.

“…Besides the paucity of studies and their methodological constraints (for a review, see Everaert et al, 2012), more importantly, we still lack a comprehensive insight into the (time)course of processing biases. That is, it remains untested how attention is deployed while emotional information is interpreted and how this sets the stage for emotional biases in memory.…”

“…While this approach improves insight in how a specific bias affects behavior, it is also limited in that it does not show how these biased cognitive processes interact, which is a prerequisite for profound insight in each individual cognitive bias as well as emotionally distorted cognitive functioning as a whole. Acknowledging this limitation, a consensus is growing among theorists that cognitive biases should be studied in an integrative manner (e.g., Everaert, Koster, & Derakshan, 2012;Hertel & Brozovich, 2010;Hirsch, Clark, & Mathews, 2006). Interrelations among cognitive biases have been considered since the earliest theoretical frameworks of emotional processing in depression (e.g., Clark, Beck, & Alford, 1999;Ingram, 1984;Williams, Watts, MacLeod, & Mathews, 1988, 1997.…”

The indirect effect of attention bias on memory via interpretation bias: Evidence for the combined cognitive bias hypothesis in subclinical depression

“…In recent years, there is a growing consensus that cognitive biases should be studied in an integrative manner to augment understanding of each particular process as well as disordered cognitive functioning (see Everaert, Koster, & Derakshan, 2012;Hertel & Brozovich, 2010;Hirsch, Clark, & Mathews, 2006). It has been advocated that biased cognitive processes influence each other in that a bias at one stage (e.g., attention) affects the processing of this information at the other stages (e.g., interpretation).…”

“…At the process level, considerable empirical research has shown that both subclinically and clinically depressed individuals selectively attend to negative information, tend to interpret ambiguous information in a negative manner, and recall disproportionately more negative memories (for reviews, see Gotlib & Joormann, 2010). Although there is extensive evidence supporting attention, interpretation, and memory biases in depression, the interplay between these cognitive mechanisms is not well understood.In recent years, there is a growing consensus that cognitive biases should be studied in an integrative manner to augment understanding of each particular process as well as disordered cognitive functioning (see Everaert, Koster, & Derakshan, 2012;Hertel & Brozovich, 2010;Hirsch, Clark, & Mathews, 2006). It has been advocated that biased cognitive processes influence each other in that a bias at one stage (e.g., attention) affects the processing of this information at the other stages (e.g., interpretation).…”

The ‘affect tagging and consolidation’ (ATaC) model of depression vulnerability

“…Panel (b) represents increased REM sleep density, which would lead to a general enhancement in emotional memory according to the ATaC model. Panel (c) represents negatively-biased amygdala activity interacting with increased REM sleep density to cause a negative memory bias, which is believed to increase vulnerability to depression (Beck, 1967;Everaert, Koster, & Derakshan, 2012). N1, N2 and N3 -stages of non-REM (NREM) sleep.…”