Elsevier

Journal of Affective Disorders

Volume 238, 1 October 2018, Pages 94-100
Journal of Affective Disorders

Research paper
Free viewing of sad and happy faces in depression: A potential target for attention bias modification

https://doi.org/10.1016/j.jad.2018.05.047Get rights and content

Highlights

  • Depressed participants dwell longer on sad faces compared to healthy controls.

  • Non-depressed participants dwell longer on happy faces compared to sad faces.

  • First fixation measures do not differ depressed from non-depressed participants.

  • The task shows high internal consistency and acceptable test-retest reliability.

  • Results suggest a potential target for therapeutic intervention in depression.

Abstract

Background

Identification of reliable targets for therapeutic interventions is essential for developing evidence-based therapies. Attention biases toward negative-valenced information and lack of protective positive bias toward positive-valenced stimuli have been implicated in depression. However, extant research has typically used tasks with narrow stimuli arrays and unknown or poor psychometric properties. Here, we recorded eye-tracking data of depressed and non-depressed participants during a free viewing task to address these limitations.

Methods

Patients with major depressive disorder (MDD; n = 20) and undergraduate students with high (n = 23) and low (n = 20) levels of depression freely viewed 60 different face-based matrices for six seconds each. Each matrix included eight sad and eight happy facial expressions. Gaze patterns on sad and happy areas of interest (AOIs) were explored. Internal consistency for the entire sample and one-week test-retest reliability in the student sub-sample were assessed.

Results

Compared to undergraduates with low levels of depression, patients with MDD and students with high levels of depression dwelled significantly longer on sad faces. Results also showed a significantly longer dwell time on the happy AOI relative to the sad AOI only in the low depression group. The two depressed groups dwelled equally on the two AOIs. The task demonstrated high internal consistency and acceptable one-week test-retest reliability.

Limitations

Only sad and happy facial expressions were used. Relative small sample size.

Conclusion

Relative to non-depressed participants, depressed participants showed prolonged dwelling on sad faces and lack of bias toward happy faces. These biases present viable targets for gaze-contingent attention bias modification therapy.

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.

References (47)

  • N. Tottenham et al.

    The NimStim set of facial expressions: judgments from untrained research participants

    Psychiatry Res.

    (2009)
  • L.B. Alloy et al.

    Judgment of contingency in depressed and nondepressed students: Sadder but wiser

    J. Exp. Psychol.

    (1979)
  • L.B. Alloy et al.

    Chapter: depressive realism: four theoretical perspectives

  • Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • A.T. Beck

    Depression: Causes and Treatment

    (1967)
  • A.T. Beck

    Cognitive Therapy and the Emotional Disorders

    (1976)
  • X. Caseras et al.

    Biases in visual orienting to negative and positive scenes in dysphoria: an eye movement study

    J. Abnorm. Psychol.

    (2007)
  • D.A. Clark et al.

    Scientific Foundations of Cognitive Therapy and Therapy of Depression

    (1999)
  • R. De Raedt et al.

    Understanding vulnerability for depression from a cognitive neuroscience perspective: a reappraisal of attentional factors and a new conceptual framework

    Cognit. Affect. Behav. Neurosci.

    (2010)
  • G.R.A. Ferrari et al.

    Can't look away: an eye-tracking based attentional disengagement training for depression

    Cognit. Therapy Res.

    (2016)
  • I.H. Gotlib et al.

    Cognition and depression: current status and future directions

    Annu. Rev. Clin. Psychol.

    (2010)
  • I.H. Gotlib et al.

    Coherence and specificity of information-processing biases in depression and social phobia

    J. Abnorm. Psychol.

    (2004)
  • I.H. Gotlib et al.

    Attentional biases for negative interpersonal stimuli in clinical depression

    J. Abnorm. Psychol.

    (2004)
  • Cited by (69)

    View all citing articles on Scopus
    1

    This work reflects equal contribution of the first three authors.

    View full text