Research paperFree viewing of sad and happy faces in depression: A potential target for attention bias modification
Introduction
Cognitive models relate attention biases to depression (Beck, 1967, Beck, 1976, Clark et al., 1999, Teasdale, 1988), whereby the attention system of depressed individuals, unlike in non-depressed individuals, prioritizes negative-valence over positive and neutral information (Dalgleish and Watts, 1990, De Raedt and Koster, 2010, Koster et al., 2011, Peckham et al., 2010). In addition, some models suggest that depressed individuals also fail to demonstrate a positivity bias observed in non-depressed individuals (Alloy and Abramson, 1979, Alloy and Abramson, 1988, Matthews and Antes, 1992).
Research using reaction-time (RT) to quantify attention processes in MDD finds some evidence of attention bias toward negative information (Gotlib and Joormann, 2010, Peckham et al., 2010), with such biases, when revealed, typically emerging only when employing long (>1,000 ms) stimulus exposure durations (De Raedt and Koster, 2010, Gotlib and Joormann, 2010, Peckham et al., 2010). Some RT-based attentional research has also demonstrated a lack of a “protective bias” in depression. That is, depressed individuals typically lack an attentional preference for positive over negative information, which characterizes non-depressed individuals (Gotlib et al., 1988, Matthews and Antes, 1992, Mccabe and Gotlib, 1995, Peckham et al., 2010, Shane and Peterson, 2007). However, concerns about poor psychometric properties (i.e., internal consistency and test-retest reliability) of RT-based attention bias indices have lead research to employ alternative eye-tracking measures of attention, which were shown to be more reliable compared with RT measures (Skinner et al., 2017, Waechter et al., 2014). A meta-analysis of free-viewing eye-tracking studies concluded that depression involves reduced gaze maintenance on positive stimuli and increased gaze maintenance on negative-valence stimuli (Armstrong and Olatunji, 2012), with two more recent studies showing similar results in clinically diagnosed MDD patients (Duque and Vazquez, 2015, Lu et al., 2017). Other eye-tracking-based paradigms have reported similar results. For example, research using the attentional engagement-disengagement task, designed specifically to examine volitional disengagement of attention, has showed that depressed participants take longer to disengage sad faces and shift gaze towards neutral faces when explicitly prompted to do so (Sanchez et al., 2017, Sanchez et al., 2013).
Despite these coherent and promising findings, extant eye-tracking research has two main limitations. First, research has exclusively used stimulus sets with four or fewer items, limiting generalizability. Stronger, more generalizable results may arise via studies using more complex visual displays, thus extending extant findings in the field (Ferrari et al., 2016, Lazarov et al., 2016, Mogoase et al., 2014, Price et al., 2016, Richards et al., 2014). Second, no eye-tracking study to date has examined the test-retest reliability of attention bias indices in depression, with only one previous study reporting on acceptable internal consistency (Sanchez et al., 2017). In research on anxiety, Lazarov et al. (2016) addressed these two limitations, using a free viewing eye-tracking task, serving also as unique targets for a novel treatment (Lazarov et al., 2017). Given the high co-morbidity between anxiety and depression, the current study extends work on biased gaze patterns in anxiety to quantify a reliable indicator of attention biases in major depressive disorder (MDD). We recorded eye-tracking data while participants freely viewed visual displays comprised of happy and sad faces (16 faces per display), presented for 6 s each. We measured the gaze patterns of three groups of participants: undergraduate students with high or low levels of depressive symptoms, and a group of clinically diagnosed treatment-seeking patients with MDD. Internal consistency and one-week test-retest reliability were evaluated. Based on previous findings, we expected that relative to non-depressed participants, depressed participants would dwell longer on sad faces and shorter on happy faces.
Section snippets
Participants
Participants in this study belonged to three groups: undergraduate students with high levels of depressive symptoms, undergraduate students with low levels of depressive symptoms, and treatment-seeking patients with clinically diagnosed MDD. The clinical group consisted of 20 treatment-seeking patients diagnosed with MDD (7 females, mean age = 40.28 years, SD = 10.40, range = 23–58). Primary and co-morbid diagnoses were ascertained using the Mini-International Neuropsychiatric Interview (see
Demographic and clinical characteristics
Demographic and clinical characteristics of the three groups are described in Table 1. As expected, significant group differences were noted for depression scores on the PHQ-9, F(2, 60) = 187.91, p < .001, η2p= .86. Follow-up analyses revealed a higher score for the MDD group compared with both the HD group, t(41) = 4.44, p < .001, Cohen's d = 1.35, and the LD group, t(38) = 19.01, p < .001, Cohen's d = 6.01. In addition, by definition, the HD group had a higher score compared with the LD
Discussion
The present study compared gaze patterns during passive viewing of emotional faces among healthy and depressed participants. Two main results emerged. First, as compared to non-depressed students, both depressed students and patients with MDD dwelled longer on sad faces and equally divided viewing times between happy and sad faces. This contrasted with non-depressed students, who dwelled significantly longer on happy faces. Second, as in previous studies using distinct face emotions (Lazarov
Authors declaration
We declare that this manuscript is original and that it has not been published before or has been posted on a web site and that it is not currently being considered for publication elsewhere.
Funding
This research was partially supported by the United States-Israel Binational Science Foundation (grant number 2013349) and National Institute of Mental Health grant T32-MH020004 (Amit Lazarov). The funding agency had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Acknowledgment
We greatly appreciate and thank the MDD patients and healthy volunteers who participated in this study.
Institutional Board Review
The authors assert that all procedures contributing to this work comply with APA ethical standards and with the Helsinki Declaration of 1975, as revised in 2008. All procedure were approved by the committees on human experimentation in Tel Aviv University.
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This work reflects equal contribution of the first three authors.