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Brain of Thrones: Cognitive Effort and Perceived Performance During a Cognitive Task in Major Depressive Disorder

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Abstract

Background

Cognitive impairment is a characteristic feature of depression and a robust predictor of everyday functioning. Cognitive remediation is a promising treatment for neurocognitive dysfunction in depression. However, treatment studies have shown that those with depression often do not apply their cognitive gains to everyday life. Features of depression may account for mixed outcomes, including avoidance and negative perceptions of abilities. The present investigation examined how individuals with depression engage with a novel cognitive task created to resemble exercises used in cognitive remediation.

Methods

Twenty-eight individuals with depression and 24 healthy comparison (HC) participants completed a computerized cognitive task while EEG was recorded. Participants were asked to indicate how they would like to adjust task difficulty and how many of the trials they believed they got correct.

Results

Participants with depression did not significantly differ from HC on objective performance accuracy. However, participants with depression opted to decrease their difficulty level significantly more than HC on high challenge levels. Additionally, individuals with depression had significantly greater EEG alpha power on high challenge levels than low challenge levels, suggesting increased disengagement from the task on more challenging levels.

Conclusions

Avoidance of cognitive challenges in depression has implications for understanding mechanisms related to cognitive performance and efforts to modify cognitive impairment.

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References

  • Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

    Book  Google Scholar 

  • Andersen, S. B., Moore, R. A., Venables, L., & Corr, P. J. (2009). Electrophysiological correlates of anxious rumination. International Journal of Psychophysiology, 71(2), 156–169.

    Article  PubMed  Google Scholar 

  • Baune, B. T., Miller, R., McAfoose, J., Johnson, M., Quirk, F., & Mitchell, D. (2010). The role of cognitive impairment in general functioning in major depression. Psychiatry Research, 176(2), 183–189.

    Article  PubMed  Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row.

    Google Scholar 

  • Beck, A. T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy, 1, 5–37.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory-II.

  • Best, M. W., & Bowie, C. R. (2017). A review of cognitive remediation approaches for schizophrenia: From top-down to bottom-up, brain training to psychotherapy. Expert Review of Neurotherapeutics, 17(7), 713–723.

    Article  CAS  PubMed  Google Scholar 

  • Bora, E., Harrison, B. J., Yücel, M., & Pantelis, C. (2013). Cognitive impairment in euthymic major depressive disorder: A meta-analysis. Psychological Medicine, 43(10), 2017–2026.

    Article  CAS  PubMed  Google Scholar 

  • Bortolato, B., Miskowiak, K. W., Köhler, C. A., Maes, M., Fernandes, B. S., Berk, M., et al. (2016). Cognitive remission: A novel objective for the treatment of major depression? BMC Medicine, 14(1), 9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Bowie, C. R. (2014). Cognitive remediation for major depressive disorder. In R. McIntyre & D. Cha (Eds.), Cognitive impairment in major depressive disorder. Cambridge: Cambridge Press.

    Google Scholar 

  • Bowie, C. R., Grossman, M., Gupta, M., Holshausen, K., & Best, M. W. (2016). Action-based cognitive remediation for individuals with serious mental illnesses: Effects of real-world simulations and goal setting on functional and vocational outcomes. Psychiatric Rehabilitation Journal, 40(1), 53–60.

    Article  PubMed  Google Scholar 

  • Bowie, C. R., Gupta, M., & Holshausen, K. (2013a). Cognitive remediation therapy for mood disorders. The Canadian Journal of Psychiatry, 58(6), 319–325.

    Article  PubMed  Google Scholar 

  • Bowie, C. R., Gupta, M., Holshausen, K., Jokic, R., Best, M., & Milev, R. (2013b). Cognitive remediation for treatment-resistant depression: Effects on cognition and functioning and the role of online homework. The Journal of Nervous and Mental Disease, 201(8), 680–685.

    Article  PubMed  Google Scholar 

  • Bowie, C. R., Milanovic, M., Tran, T., & Cassidy, S. (2017). Disengagement from tasks as a function of cognitive load and depressive symptom severity. Cognitive Neuropsychiatry, 22(1), 83–94.

    Article  PubMed  Google Scholar 

  • Buist‐Bouwman, M. A., Ormel, J., De Graaf, R., De Jonge, P., Van Sonderen, E., Alonso, J., … Vollebergh, W. A. M. (2008). Mediators of the association between depression and role functioning. Acta Psychiatrica Scandinavica, 118(6), 451-458.

  • Conradi, H. J., Ormel, J., & De Jonge, P. (2011). Presence of individual (residual) symptoms during depressive episodes and periods of remission: A 3-year prospective study. Psychological Medicine, 41(6), 1165–1174.

    Article  CAS  PubMed  Google Scholar 

  • Dunn, B. D., Dalgleish, T., Lawrence, A. D., & Ogilvie, A. D. (2007). The accuracy of self-monitoring and its relationship to self-focused attention in dysphoria and clinical depression. Journal of Abnormal Psychology, 116(1), 1.

    Article  PubMed  Google Scholar 

  • Elliott, R., Sahakian, B. J., McKay, A. P., Herrod, J. J., Robbins, T. W., & Paykel, E. S. (1996). Neuropsychological impairments in unipolar depression: The influence of perceived failure on subsequent performance. Psychological Medicine, 26(5), 975–989.

    Article  CAS  PubMed  Google Scholar 

  • Elliott, R., Sahakian, B. J., Herrod, J. J., Robbins, T. W., & Paykel, E. S. (1997). Abnormal response to negative feedback in unipolar depression: Evidence for a diagnosis specific impairment. Journal of Neurology, Neurosurgery & Psychiatry, 63(1), 74–82.

    Article  CAS  Google Scholar 

  • Ellis, H. C., & Ashbrook, P. W. (1988). Resource allocation model of the effects of depressed mood states on memory. In K. Fiedler & L. Jorgas (Eds.), Affect cognition and social behaviour—New evidence and integrative attempts (pp. 25–43). Gottingen: Mogrefe.

    Google Scholar 

  • Gold, J. M., Carpenter, C., Randolph, C., Goldberg, T. E., & Weinberger, D. R. (1997). Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Archives of General Psychiatry, 54, 159–165.

    Article  CAS  PubMed  Google Scholar 

  • Gorwood, P., Corruble, E., Falissard, B.,Goodwin. D. (2008). Toxic effects of depression on brain function: Impairment of delayed recall and the cumulative length of depressive disorder in a large sample of depressed outpatients. American Journal of Psychiatry, 165(6), 731–739.

    Article  Google Scholar 

  • Hammar, A. (2003). Automatic and effortful information processing in unipolar major depression. Scandinavian Journal of Psychology, 44(5), 409–413.

    Article  PubMed  Google Scholar 

  • Hammar, A., Strand, M., Ardal, G., Schmid, M., Lund, A., & Elliott, R. (2011). Testing the cognitive effort hypothesis of cognitive impairment in major depression. Nordic Journal of Psychiatry, 65(1), 74–80.

    Article  PubMed  Google Scholar 

  • Hasher, L., & Zacks, R. T. (1979). Automatic and effortful processes in memory. Journal of Experimental Psychology: General, 108(3), 356–388.

    Article  Google Scholar 

  • Hasselbalch, B. J., Knorr, U., & Kessing, L. V. (2011). Cognitive impairment in the remitted state of unipolar depressive disorder: A systematic review. Journal of Affective Disorders, 134(1), 20–31.

    Article  PubMed  Google Scholar 

  • Holmes, A. J., & Pizzagalli, D. A. (2007). Task feedback effects on conflict monitoring and executive control: Relationship to subclinical measures of depression. Emotion, 7(1), 68.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatric Research, 145(1), 39–48.

    Article  Google Scholar 

  • Jensen, O., & Tesche, C. D. (2002). Frontal theta activity in humans increases with memory load in a working memory task. European journal of Neuroscience, 15(8), 1395–1399.

    Article  Google Scholar 

  • Joormann, J., & Gotlib, I. H. (2008). Updating the contents of working memory in depression: Interference from irrelevant negative material. Journal of Abnormal Psychology, 117(1), 182–192.

    Article  PubMed  Google Scholar 

  • Keefe, R. S., Goldberg, T. E., Harvey, P. D., Gold, J. M., Poe, M. P., & Coughenour, L. (2004). The Brief Assessment of Cognition in Schizophrenia: Reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research, 68(2), 283–297.

    Article  PubMed  Google Scholar 

  • Klimesch, W. (1999). EEG alpha and theta oscillations reflect cognitive and memory performance: A review and analysis. Brain Research Reviews, 29(2), 169–195.

    Article  CAS  PubMed  Google Scholar 

  • Knyazev, G. G., Slobodskoj-Plusnin, J. Y., Bocharov, A. V., & Pylkova, L. V. (2011). The default mode network and EEG alpha oscillations: An independent component analysis. Brain Research, 1402, 67–79.

    Article  CAS  PubMed  Google Scholar 

  • Lahr, D., Beblo, T., & Hartje, W. (2007). Cognitive performance and subjective complaints before and after remission of major depression. Cognitive Neuropsychiatry, 12(1), 25–45.

    Article  PubMed  Google Scholar 

  • Lee, R. S., Hermens, D. F., Porter, M. A., & Redoblado-Hodge, M. A. (2012). A meta-analysis of cognitive deficits in first-episode major depressive disorder. Journal of Affective Disorders, 140(2), 113–124.

    Article  PubMed  Google Scholar 

  • Lim, G. Y., Tam, W. W., Lu, Y., Ho, C. S., Zhang, M. W., & Ho, R. C. (2018). Prevalence of depression in the community from 30 countries between 1994 and 2014. Scientific Reports, 8(1), 2861.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: WW Norton & Co.

    Google Scholar 

  • McGurk, S. R., Mueser, K. T., Feldman, K., Wolfe, R., & Pascaris, A. (2007). Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. American Journal of Psychiatry, 164(3), 437–441.

    Article  Google Scholar 

  • McIntyre, R. S., Cha, D. S., Soczynska, J. K., Woldeyohannes, H. O., Gallaugher, L. A., Kudlow, P., … Baskaran, A. (2013). Cognitive deficits and functional outcomes in major depressive disorder: Determinants, substrates, and treatment interventions. Depression and Anxiety, 30(6), 515–527.

  • McIntyre, R. S., & Lee, Y. (2016). Cognition in major depressive disorder: A ‘Systemically Important Functional Index’ (SIFI). Current Opinion in Psychiatry, 29(1), 48–55.

    Article  PubMed  Google Scholar 

  • Medalia, A., Revheim, N., & Herlands, T. (2009). Cognitive remediation for psychological disorders: Therapist guide. USA: Oxford University Press.

    Book  Google Scholar 

  • Motter, J. N., Pimontel, M. A., Rindskopf, D., Devanand, D. P., Doraiswamy, P. M., & Sneed, J. R. (2016). Computerized cognitive training and functional recovery in major depressive disorder: A meta-analysis. Journal of Affective Disorders, 189, 184–191.

    Article  PubMed  Google Scholar 

  • Naismith, S. L., Diamond, K., Carter, P. E., Norrie, L. M., Redoblado-Hodge, M. A., Lewis, S. J., et al. (2011). Enhancing memory in late-life depression: The effects of a combined psychoeducation and cognitive training program. The American Journal of Geriatric Psychiatry, 19(3), 240–248.

    Article  PubMed  Google Scholar 

  • Naismith, S. L., Redoblado-Hodge, M. A., Lewis, S. J., Scott, E. M., & Hickie, I. B. (2010). Cognitive training in affective disorders improves memory: A preliminary study using the NEAR approach. Journal of Affective Disorders, 121(3), 258–262.

    Article  PubMed  Google Scholar 

  • Onton, J., Delorme, A., & Makeig, S. (2005). Frontal midline EEG dynamics during working memory. Neuroimage, 27(2), 341–356.

    Article  PubMed  Google Scholar 

  • Partington, J. E., & Leiter, R. G. (1949). Halstead-Reitan trail making test. Arizona: Reitan Neuropsychology Laboratory.

    Google Scholar 

  • Quigley, L., Wen, A., & Dobson, K. S. (2017). Avoidance and depression vulnerability: An examination of avoidance in remitted and currently depressed individuals. Behaviour Research and Therapy, 97, 183–188.

    Article  PubMed  Google Scholar 

  • Raichle, M. E. (2015). The brain's default mode network. Annual Review of Neuroscience, 38, 433–447.

    Article  CAS  PubMed  Google Scholar 

  • Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44(10), 2029–2040.

    Article  CAS  PubMed  Google Scholar 

  • Rowland, N., Meile, M. J., & Nicolaidis, S. (1985). EEG alpha activity reflects attentional demands, and beta activity reflects emotional and cognitive processes. Science, 228(4700), 750–752.

    Article  Google Scholar 

  • Sheehan, D. V., Lecrubier, Y., Harnett-Sheehan, K., Amorim, P., Janavs, J., Weiller, E., …, Dunbar, G. (1998). The M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry, 59(suppl 20): 22–33.

  • Spreen, O. D., & Strauss, E. (1998). A compendium of neuropsychologial tests. In Administration, norms, and commentary. Oxford: Oxford University Press.

  • Srisurapanont, M., Bautista, D., Chen, C. H., Wang, G., Udomratn, P., & Eurviriyanukul, K. (2015). Subjective memory and concentration deficits in medication-free, non-elderly Asians with major depressive disorder: Prevalence and their correlates. Journal of Affective Disorders, 171, 105–110.

    Article  PubMed  Google Scholar 

  • Steffens, D. C., Wagner, H. R., Levy, R. M., Horn, K. A., & Krishnan, K. R. R. (2001). Performance feedback deficit in geriatric depression. Biological Psychiatry, 50(5), 358–363.

    Article  CAS  PubMed  Google Scholar 

  • Svendsen, A. M., Kessing, L. V., Munkholm, K., Vinberg, M., & Miskowiak, K. W. (2012). Is there an association between subjective and objective measures of cognitive function in patients with affective disorders? Nordic Journal of Psychiatry, 66(4), 248–253.

    Article  PubMed  Google Scholar 

  • Tran, T., Hagen, E.F., Hollenstein, T., & Bowie, C. R. (2019). Physical and cognitive effort-based decision-making in depression: Relationship to symptoms and functioning. Manuscript under review for publication.

  • Vanderhasselt, M. A., & De Raedt, R. (2009). Impairments in cognitive control persist during remission from depression and are related to the number of past episodes: An event related potentials study. Biological Psychology, 81(3), 169–176.

    Article  CAS  PubMed  Google Scholar 

  • Wechsler, D. (2008). Wechsler Memory Scale (4th ed.). San Antonio, TX: Pearson.

    Google Scholar 

  • Weiland-Fiedler, P., Erickson, K., Waldeck, T., Luckenbaugh, D. A., Pike, D., Bonne, O., … Neumeister, A. (2004). Evidence for continuing neuropsychological impairments in depression. Journal of Affective Disorders, 82(2), 253–258.

  • World Health Organization. (2017). Depression and other common mental disorders global health estimates. Retrieved from https://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/.

  • Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168(5), 472–485.

    Article  Google Scholar 

  • Zimmerman, M., Martinez, J., Attiullah, N., Friedman, M., Toba, C., & Boerescu, D. A. (2012). Symptom differences between depressed outpatients who are in remission according to the Hamilton Depression Rating Scale who do and do not consider themselves to be in remission. Journal of Affective Disorders, 142(1–3), 77–81.

    Article  PubMed  Google Scholar 

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Funding

The research was supported in part by grants from the Healthy Minds Canada/Sun Life Mutual/Pfizer Canada Award (CRB, Grant Number N/A), and the Queen’s University Senate Research Advisory Council Award (CRB, Grant Number N/A) a Canadian Institutes of Health Research Vanier Canada Graduate Scholarship (MWB), and a Joseph-Armand Bombardier Doctoral Canada Graduate Scholarship from the Social Sciences and Humanities Research Council (MM).

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Authors and Affiliations

  1. Department of Psychology, Queen’s University, Kingston, ON, K7L 3L3, Canada

    Chelsea Wood-Ross, Melissa Milanovic & Christopher R. Bowie

  2. Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada

    Michael W. Best

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  1. Chelsea Wood-Ross
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  2. Michael W. Best
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  3. Melissa Milanovic
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  4. Christopher R. Bowie
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Correspondence to Christopher R. Bowie.

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Conflict of interest

Christopher R. Bowie has received research grants from Lundbeck, Takeda, and Pfizer. Christopher R. Bowie consults for Boehringer, Ingelheim, Pfizer, and Lundbeck. Christopher R. Bowie receives in-kind research support from Scientific Brain Training, and received royalties from Oxford University Press. Chelsea Wood-Ross, Michael W. Best, and Melissa Milanovic declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethical committee of the General Research Ethics Board at Queen’s University (GREB reference: GPSYC-786-16) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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No animal studies were carried out by the authors for this article.

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Wood-Ross, C., Best, M.W., Milanovic, M. et al. Brain of Thrones: Cognitive Effort and Perceived Performance During a Cognitive Task in Major Depressive Disorder. Cogn Ther Res 45, 986–999 (2021). https://doi.org/10.1007/s10608-020-10145-w

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