ReviewDistorted Cognitive Processes in Major Depression: A Predictive Processing Perspective
Section snippets
Traditional Cognitive Model
The cognitive model of depression described by Beck et al. 1, 2, 3 has provided a fruitful theoretical framework for understanding major depressive disorder (MDD), assuming that people with MDD tend to interpret environmental experiences in a negative fashion. It has been hypothesized that this maladaptive information processing is caused by dysfunctional cognitions (1), as illustrated in Supplemental Figure S1.
Although this model has been deeply influential in research into depression for
Relevance of Expectations for the Development of Depressive Symptoms
Research has consistently revealed associations between depressive symptoms and different types of expectations, such as low self-efficacy expectancies 7, 8, 9 and negative global expectations about future events 10, 11, 12. Furthermore, a longitudinal study has shown that in youths seeking emergency psychiatric care, patients’ self-rated expectations of suicidal behavior predicted actual suicidal attempts over a period of 18 months (13).
Recent studies have further specified how exactly
Predictive Processing
Parallel to the clinical literature, expectations have been studied in a very dynamic field of research in cognitive neuroscience, which, with some important exceptions 16, 17, has rarely been connected with theoretical models of depression: predictive coding and error processing. According to this literature, the brain is neither passive nor stimulus driven. Rather, with reference to Bayesian models, which explain how the brain handles uncertainty (18), the brain actively generates top-down
Behavioral Studies
Several lines of research converge on the finding that people with MDD have difficulty updating negative expectations after unexpected positive experiences. First, research on interpretations biases has shown that people with MDD tend to interpret ambiguous situations often negatively and less often positively, especially if they contain self-referential stimuli (55). Moreover, it has been indicated that people with MDD maintain established negative interpretations of ambiguous information even
Synthesis of Evidence: An Expectation-Focused Model of Depression
As a synthesis of the recent findings reviewed above, we propose a novel explanatory model for the development and maintenance of depression. The first part of the model refers to the role of expectations in the exacerbation of depression, as illustrated and explained in more detail in Figure 1. In brief, this model suggests that people with MDD hold negative generalized expectations, which, when exposed to particular situations, elicit negative situational predictions that evoke depressive
Future Work
A significant limitation of previous research is that researchers often distinguished between expectation confirmation versus disconfirmation as if they were binary concepts. In fact, disconfirming experiences can vary greatly in the extent to which they contradict one’s expectations. Therefore, it may be important for future research to examine how healthy people versus people with MDD update their expectations depending on the magnitude of the PE. As illustrated in Supplemental Figure S3, we
Conclusions
This article aimed to connect disparate bodies of literature to provide a new framework for understanding distorted cognitive processes in depression. We proposed an explanatory model suggesting that patients with depression hold negative expectations about future experiences, which they subjectively feel confirmed owing to discounting disconfirmatory positive information. In computational terms, we suggest that the main candidate of pathology in MDD is too much precision afforded to prior
Acknowledgments and Disclosures
Although the present article received no funding, it was conducted in the context of the Research Training Group 2271 “Breaking Expectations: Expectation Maintenance vs. Change in the Context of Expectation Violations,” located at Philipps-University of Marburg.
We thank all members of Research Training Group 2271, who inspired and supported the present work. Figure 2B was created with Motifolio drawing toolkits (www.motifolio.com).
The authors report no biomedical financial interests or
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