Transcript Attention, Emotion and Memory in Depression & Anxiety

Attention,
Emotion
& Memory in
Depression
& Anxiety
Basics and Definitions
Konstantinos G. Zeimpekis, MSc, DIC
22 November 2013
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Cognitive
Functions
Anxiety and
Depression
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Attention
Emotion
Memory
Brain Imaging
MR Diffusion Tensor Imaging
Tractography
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PET scan
Attention
Frontal Lobe &
Thalamus,
Hypothalamus
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Memory
Temporal lobe,
Hippocampus, Amygdala,
Basal Ganglia
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Emotion
Amygdala
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Brain in Depression
- limbic system
 anterior cingulate cortex
+ dorsolateral prefrontal cortex
difficulty recruiting brain regions for cognitive
control
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Brain in Depression
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Theories
o Self - World - Future
o Stimuli is congruent with certain schemas
(loss, separation, failure etc)(Beck 1976)
o Congruent life events
negative automatic thoughts
processing biases
depressed mood
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Depression
 Increased elaboration of negative information
 Difficulty in disengaging from negative
material
 Deficits in cognitive control when negative
information is processed.
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Depression
 Concentration & 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)
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Depression
 MDD is characterized by negative automatic
thoughts and biases in attention,
interpretation and memory
 Vulnerability
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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)
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Anxiety models
• panic disorder
catastrophic interpretative bias
• social phobia
focused attentional bias
• clinical depression
negative attributional style and rumination
• GAD
“worry about worry”
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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)
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Emotion Dysregulation
o difficulties disengaging from negative material
o impaired emotion regulation
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Cognition and Emotion Dysregulation
Anxiety
quick detection of and fast orienting toward
threat-related stimuli
Depression
once negative material has become the focus
of attention
elaboration occurs
inability to disengage and recovery
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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)
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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
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Emotion
Biases 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).
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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
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(Thorpe & Salkovskis 1998)
Emotion
o recall more unpleasant memories
o interpret ambiguous events in a more
negative manner
 Emotional processing bias
Frequent comorbidity
Anxiety : threat cues at early stages
Depression : selective attention to moodcongruent stimuli
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Attention
attentional bias
operates rapidly in anxiety
longer 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)
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Attention
Attention biases of depressed individuals are
expected to endure beyond the depressive
episode (Bower 1981)
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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)
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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 difficulty
Anxiety bias once they feel the stimulus in early
stages
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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)
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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
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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)
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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)
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Auto biographical Memory
• Negative biases in memory, interpretation and
attention
• Preferential recall of negative compared to
positive material : most robust finding
(Mathews & MacLeod 2005)
Nondepressed / bias for positive info
• Not only memory of negative events but generic
memories despite instructions to recall specific
events
(Williams et al 2007)
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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
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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)
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Overgeneral Memory
Overgenerality
general memory deficits
recalling contextual detail
Overgeneral memory is a consistent
characteristic of patients with a diagnosis of
MDD
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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
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Overgeneral Memory
Depression / Post Traumatic Stress Disorder
Overgeneral Memories
Negative experiences / trauma
events retrieval
Executive control Impairment
Failure to inhibit competing
information
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Journal Club
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Emotion
Higher-order cognitive functions
Inhibitory Control
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Journal Club
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Journal Club
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Journal Club
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Journal Club
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Thank you !