Attention, Emotion & Memory in Depression & Anxiety

Konstantinos G. Zeimpekis, MSc, DIC 22 November 2013

Attention, Emotion

& Memory in Depression

& AnxietyBasics and Definitions

Preview

Cognitive Functions

Anxiety and Depression

Attention

Emotion

Memory

Konstantinos Zeimpekis

Brain Imaging

MR Diffusion Tensor ImagingTractography

PET scan


Attention

Frontal Lobe & Thalamus, Hypothalamus


Memory

Temporal lobe, Hippocampus, Amygdala, Basal Ganglia


Emotion

Amygdala


Brain in Depression

- limbic system anterior cingulate cortex + dorsolateral prefrontal cortex

difficulty recruiting brain regions for cognitive control


Brain in Depression


Theories

o Self - World - Future

o Stimuli is congruent with certain schemas (loss, separation, failure etc)(Beck 1976)

o Congruent life events negative automatic thoughtsprocessing biases depressed mood


Depression

Increased elaboration of negative information

Difficulty in disengaging from negative material

Deficits in cognitive control when negative information is processed.


DepressionConcentration & memory deficit (Burt 1995)

Easily concentrate on negative self-focused thoughts

Enhanced recall of mood congruent material

Memory impairments not specific to depression but in general psychopathology (Burt 1995)

Not in all memory components but in free recall tasks (Hertel 1998)


Depression

MDD is characterized by negative automatic thoughts and biases in attention, interpretation and memory

Vulnerability stressor


Depression

Deficits in executive control and attentional deficits characterize depressed people whereas evidence for learning and memory deficits is more mixed (Castaneda et. al. 2008)

Difficult to differentiate between cognitive deficits and a lack of motivation that characterizes depressed patients (Scheurich et al. 2008)


Anxiety models

• panic disorder catastrophic interpretative bias

• social phobia focused attentional bias

• clinical depression negative attributional style and rumination

• GAD “worry about worry”


Cognitive Bias and Emotion Dysregulation

I. Inhibitory processes and deficits in working memory (Joormann 2005)

II. Ruminative responses to negative mood states and negative life events (Nolen-Hoeksema 2000)

III.Inability to use positive and rewarding stimuli to regulate negative mood (Joormann & Siemer 2004)


Emotion Dysregulation

o difficulties disengaging from negative material

o impaired emotion regulation


Cognition and Emotion Dysregulation

Anxietyquick detection of and fast orienting toward

threat-related stimuli

Depressiononce negative material has become the focus of attention

elaboration occursinability to disengage and recovery


Vulnerability to Emotional Disorders

1. early occurrence in the info-processing sequence (selective attention and

memory)

2. later reportable cognitive products (intrusive thoughts, worry or rumination)


Emotion

Bias not prerogative for disorder

Anxiety Disorders selective attention favoring threatening

information (Mathews & MacLeod 1994)

Depression biases in explicit memory favoring negative

self-related information


EmotionBiases and deficits in cognitive functioning,

affect people’s ability

to regulate emotion and mood states,

increasing their vulnerability to develop

emotional disorders (Joormann et al. 2009d).


Emotion

Disengagement difficulties predominate when

threats are encountered incidentally, but

anxious individuals also actively search for and

engage locations associated with potential

threat and possible escape routes (Thorpe & Salkovskis 1998)


Emotion

o recall more unpleasant memorieso interpret ambiguous events in a more negative

manner Emotional processing bias

Frequent comorbidityAnxiety : threat cues at early stagesDepression : selective attention to mood-congruent stimuli


Attentionattentional bias

operates rapidly in anxietylonger time needed for stimulus processing in depression

• Depressed attend selectively to sad faces (Eizenman 2003)

• Bias with relatively long exposure conditions is characteristic of depression, but not of anxiety disorders, may be due to early attention to threat in the anxious group being superceded by later avoidance (Gotlib 2004)


Attention

Attention biases of depressed individuals are

expected to endure beyond the depressive

episode (Bower 1981)


Attention

o Biased processing of subliminally presented anxiety-provoking stimuli (Bradley et al 1995)

o Only GAD patients exhibited that (not comorbid with depression) but GAD patients with depression did not differ from controls

o Increased attention to negative words for long time (Donaldson 2007)


Attention Depressed individuals do not direct their attention to

negative info more frequently than control do, BUT once it captures their attention they exhibit difficulties disengaging from it (Joormann & Gotlib 2007)

Selective bias for negative info different between depression and anxiety (Caseras 2007)

Depression disengagement difficultyAnxiety bias once they feel the stimulus in early

stagesKonstantinos Zeimpekis

Depression

These findings suggest that deficits in executive control and inhibition are related to sustained processing of negative material and rumination, which in turn maintains the negative mood state and hinders recovery from negative affect (Joormann & Gotlib 2008)


Memory

Autobiographical memory refers to the recall of specific incidents from one’s past, typically sampled by asking someone to produce a personal memory related to a cue word or phrase

That is, despite instructions to recall a specific event, depression-prone individuals frequently provide a general class of events


Memory

In contrast to the strong evidence of memory bias in depression, in anxiety disorders such an effect remains elusive and unconvincing, except in the case of panic disorder (Coles & Heimberg 2002, MacLeod & Mathews 2004)


Memory

It has been suggested that anxiety motivates avoidance of semantic elaboration, or promotes perceptual encoding of threat information, so it is stored in nonverbally accessible form (Brewin 2001)


Auto biographical Memory

• Negative biases in memory, interpretation and attention (Mathews & MacLeod 2005)

• Preferential recall of negative compared to positive material : most robust finding

Nondepressed / bias for positive info

• Not only memory of negative events but generic memories despite instructions to recall specific events (Williams et al 2007)


Auto biographical Memory

o Summarize categories of events rather than retrieving a single episode

capture and rumination processes

functional avoidance

impairment in executive capacity and control


Memory

Greater memory impairment when :

• Attention not constrained by task (Hertel 1991)

• Increased cognitive effort is required (Hartlage 1993)

• Attention is easily allocated to personal concerns (Ellis & Ashbrook 1988)


Overgeneral Memory

Overgenerality general memory deficitsrecalling contextual detail

Overgeneral memory is a consistent characteristic of patients with a diagnosis of

MDD


Overgeneral Memory

• Overgenerality does not occur in GAD, social phobia or blood and spider fearful individuals and it was not found in a mixed group of anxiety disorder patients (Wessel et al 2001)

• Unlike dysphoria, in which overgenerality is found, it is not found in individuals with high trait anxiety (Richards & Whittaker, 1990)

• Overgenerality– Depression– PTSD


Overgeneral MemoryDepression / Post Traumatic Stress Disorder

Overgeneral Memories

Negative experiences / trauma

events retrieval

Executive control Impairment

Failure to inhibit competing information


Journal Club


Journal Club

Emotion


Higher-order cognitive functions

Inhibitory Control

Journal Club


Journal Club


Journal Club


Journal Club


Thank you !

Documents

Attention, Emotion & Memory in Depression & Anxiety