Positive Distractors Research Articles

Aberrant brain responses to emotionally valent words is normalised after cognitive behavioural therapy in female depressed adolescents

BackgroundDepression in adolescence is debilitating with high recurrence in adulthood, yet its pathophysiological mechanism remains enigmatic. To examine the interaction between emotion, cognition and treatment, functional brain responses to sad and happy distractors in an affective go/no-go task were explored before and after Cognitive Behavioural Therapy (CBT) in depressed female adolescents, and healthy participants. MethodsEighty-two Depressed and 24 healthy female adolescents, aged 12–17 years, performed a functional magnetic resonance imaging (fMRI) affective go/no-go task at baseline. Participants were instructed to withhold their responses upon seeing happy or sad words. Among these participants, 13 patients had CBT over approximately 30 weeks. These participants and 20 matched controls then repeated the task. ResultsAt baseline, increased activation in response to happy relative to neutral distractors was observed in the orbitofrontal cortex in depressed patients which was normalised after CBT. No significant group differences were found behaviourally or in brain activation in response to sad distractors. Improvements in symptoms (mean: 9.31, 95% CI: 5.35–13.27) were related at trend-level to activation changes in orbitofrontal cortex. LimitationsIn the follow-up section, a limited number of post-CBT patients were recruited. ConclusionsTo our knowledge, this is the first fMRI study addressing the effect of CBT in adolescent depression. Although a bias toward negative information is widely accepted as a hallmark of depression, aberrant brain hyperactivity to positive distractors was found and normalised after CBT. Research, assessment and treatment focused on positive stimuli could be a future consideration. Moreover, a pathophysiological mechanism distinct from adult depression may be suggested and awaits further exploration.

On the relationship between negative affective priming and prefrontal cognitive control mechanisms

Although several studies have examined inhibition of affective stimuli, valence-dependent cognitive control effects remain poorly understood. Behavioural and functional imaging (functional magnetic resonance imaging) data were collected from 17 healthy participants to examine neural correlates of the Negative Affective Priming (NAP) task. We created relative ratio scores considering the reaction times of prime trials in order to assess the amount of interference after the presentation of negative and positive distracter words. Behavioural results showed an attenuated NAP effect for negative distracters compared to neutral stimuli. Furthermore, priming negative distracters generated more interference by reacting to the probe target than positive distracters. Neuroimaging data revealed a stronger prefrontal activation during negative NAP trials compared to positive NAP and neutral control trials, which was reflected in a heightened activation of superior and middle frontal gyrus as well as parietal cortex. The findings show the impact of negative distracters on prefrontal response, contributing to the understanding of NAP effects in healthy subjects.

Neural correlates of an early attentional capture by positive distractor words.

Exogenous or automatic attention to emotional distractors has been observed for emotional scenes and faces. In the language domain, however, automatic attention capture by emotional words has been scarcely investigated. In the current event-related potentials study we explored distractor effects elicited by positive, negative and neutral words in a concurrent but distinct target distractor paradigm. Specifically, participants performed a digit categorization task in which task-irrelevant words were flanked by numbers. The results of both temporo-spatial principal component and source location analyses revealed the existence of early distractor effects that were specifically triggered by positive words. At the scalp level, task-irrelevant positive compared to neutral and negative words elicited larger amplitudes in an anterior negative component that peaked around 120 ms. Also, at the voxel level, positive distractor words increased activity in orbitofrontal regions compared to negative words. These results suggest that positive distractor words quickly and automatically capture attentional resources diverting them from the task where attention was voluntarily directed.

Gender moderates valence effects on the late positive potential to emotional distracters

Attention is captured more strongly by emotional pictures than by neutral pictures. This allocation of attention to emotional pictures is commonly indexed by the late positive potential (LPP). This event-related potential (ERP) is larger for negative and positive pictures than for neutral pictures. However, findings are mixed in regards to valence effects, that is, whether the LPP is larger for negative pictures than for positive pictures (negativity bias) or vice versa (positivity bias). Additionally, previous ERP studies have not explicitly considered a moderating effect of gender. In the present study, positive, negative, and neutral pictures were shown at fixation but were always task-irrelevant. Results showed that LPP amplitudes for the positive and negative distracters were moderated by gender. Men showed a positivity bias on the LPP (i.e., larger amplitudes for positive pictures than for negative pictures). Women did not show a clear valence bias on the LPP, but they showed a negativity bias on picture ratings. These gender differences for the LPP did not habituate, as they were obtained even for pictures that were repeated 20 times. Because previous studies with other measures suggest a positivity bias for men and a negativity bias for women, the present findings extend these studies suggesting that attention allocation for emotional pictures of different valence is similarly moderated by gender.

Fronto-limbic function in unaffected offspring at familial risk for bipolar disorder during an emotional working memory paradigm

Evidence from neuroimaging studies indicate that individuals with bipolar disorder (BD) exhibit altered functioning of fronto-limbic systems implicated in voluntary emotion regulation. Few studies, however, have examined the extent to which unaffected youth at familial risk for BD exhibit such alterations. Using an fMRI emotional working memory paradigm, we investigated the functioning of fronto-limbic systems in fifteen healthy bipolar offspring (8–17 years old) with at least one parent diagnosed with BD (HBO), and 16 age-matched healthy control (HC) participants. Neural activity and functional connectivity analyses focused on a priori neural regions supporting emotion processing (amygdala and ventral striatum) and voluntary emotion regulation (ventrolateral prefrontal cortex (VLPFC), dorsolateral prefrontal cortex (DLPFC), and anterior cingulate cortex (ACC)). Relative to HC, HBO exhibited greater right VLPFC (BA47) activation in response to positive emotional distracters and reduced VLPFC modulation of the amygdala to both the positive and negative emotional distracters; there were no group differences in connectivity for the neutral distracters. These findings suggest that alterations in the functioning of fronto-limbic systems implicated in voluntary emotion regulation are present in unaffected bipolar offspring. Future longitudinal studies are needed to determine the extent to which such alterations represent neurodevelopmental markers of risk for future onset of BD.

A diffusion model account of the relationship between the emotional flanker task and rumination and depression.

Although there exists a consensus that depression is characterized by preferential processing of negative information, empirical findings to support the association between depression and rumination on the one hand and selective attention for negative stimuli on the other hand have been elusive. We argue that one of the reasons for the inconsistent findings may be the use of aggregate measures of response times and accuracies to measure attentional bias. Diffusion model analysis allows to partial out the information processing component from other components that comprise the decision-making process. In this study, we applied a diffusion model to an emotional flanker task. Results revealed that when focusing on a negative target, both rumination and depression were associated with facilitated processing due to negative distracters, whereas only rumination was associated with less interference by positive distracters. After controlling for depression scores, rumination still predicted attentional bias for negative information, but depression scores were no longer predictive after controlling for rumination. Consistent with elusive findings in the literature, we did not find this pattern of results when using accuracy scores or mean response times. Our results suggest that rumination accounts for the attentional bias for negative information found in depression.

The relationship between residual symptoms of depression and emotional information processing

Introduction: Depression is associated with cognitive deficits, social withdrawal and high risk of relapse. Several factors have been proposed as pertaining to increasing the risk of relapse, including a bias in emotional information processing. This study was carried out to examine the relationships between major depressive disorder (MDD), level of depressive symptoms and bias in emotional effortful information processing. Method: Nineteen patients diagnosed with recurrent MDD and 19 matched controls were tested with an experimental visual face-in-the-crowd paradigm including sad, happy and neutral information. The patients were tested on average 9 months after hospitalization. At testing, the patient group showed an overall decrease in depression severity symptom load as measured on the Hamilton Depression Rating Scale (HDRS), but with variable symptom load. Results: Reaction time (RT) did not vary between patients and controls in the visual face-in-the-crowd task or on a measure of psychomotor speed. In the patient group, symptom load was related to longer RTs when negative targets were shown against positive distractors. The results revealed a specific bias in response to negative emotional information. Conclusions: Symptom load in the patient group is related to a negative bias in emotional information processing that cannot be explained by psychomotor retardation.

Emotive interference during cognitive processing in major depression: An investigation of lower alpha 1 activity

Individuals with Major Depressive Disorder (MDD) tend to be more susceptible to distraction by negative emotional material than their non-depressed counterparts. This extends to an enhanced vulnerability to interference from mood-congruent stimuli during cognitive processing. The current study investigated the electrophysiological correlates of competing cognitive and emotional processing demands in MDD. Event-related alpha activity within the lower alpha 1 band was examined during the online information retention phase of a non-emotive WM task with extraneous emotional stimuli (positive, negative and neutral) presented as background images. EEG activity over posterior parietal cortex was compared between 15 acutely depressed and 16 never depressed right-handed women. A valence specific dissociation in lower alpha 1 activity was observed between the two groups, consistent with greater attentional resource allocation to positive distracters in control participants and to negative distracters in MDD participants. No group differences were seen when neutral distracters were displayed. These results demonstrate that activity within the lower alpha 1 band is sensitive to competing emotional and cognitive processing demands and highlight the importance of posterior parietal regions in depression-related susceptibility to affective distractibility during cognitive processing.

Sensory environment on health-related outcomes of hospital patients

Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care. To assess the effect of hospital environments on adult patient health-related outcomes. We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification. Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes. Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study. Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm. Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place.

Is There a Valence-Specific Pattern in Emotional Conflict in Major Depressive Disorder? An Exploratory Psychological Study

ObjectivePatients with major depressive disorder (MDD) clinically exhibit a deficit in positive emotional processing and are often distracted by especially negative emotional stimuli. Such emotional-cognitive interference in turn hampers the cognitive abilities of patients in their ongoing task. While the psychological correlates of such emotional conflict have been well identified in healthy subjects, possible alterations of emotional conflict in depressed patients remain to be investigated. We conducted an exploratory psychological study to investigate emotional conflict in MDD. We also distinguished depression-related stimuli from negative stimuli in order to check whether the depression-related distractors will induce enhanced conflict in MDD.MethodsA typical word-face Stroop paradigm was adopted. In order to account for valence-specificities in MDD, we included positive and general negative as well as depression-related words in the study.ResultsMDD patients demonstrated a specific pattern of emotional conflict clearly distinguishable from the healthy control group. In MDD, the positive distractor words did not significantly interrupt the processing of the negative target faces, while they did in healthy subjects. On the other hand, the depression-related distractor words induced significant emotional conflict to the positive target faces in MDD patients but not in the healthy control group.ConclusionOur findings demonstrated for the first time an altered valence-specific pattern in emotional conflict in MDD patients. The study sheds a novel and specific light on the affective mechanisms underlying the abnormal emotional-cognitive interference in MDD. Such emotional conflict bears important clinical relevance since it may trigger the widespread cognitive dysfunctions frequently observed in MDD. The present findings may have important clinical implications in both prediction and psychotherapy of MDD.

Abnormal anterior cingulate cortical activity during emotional n-back task performance distinguishes bipolar from unipolar depressed females

Depression in the context of bipolar disorder (BDd) is often misdiagnosed as unipolar disorder depression (UDd) leading to poor clinical outcomes for many bipolar sufferers. We examined neural circuitry supporting emotion regulation in females with either BDd or UDd as a first stage toward identifying biomarkers that may differentiate BDd from UDd. Fifty-seven females aged 18-45 years participated in this study: 23 with UDd, 18 with bipolar disorder type I depression (BDId) and 16 healthy females. During 3-T functional magnetic resonance imaging (fMRI), the participants performed an emotional face n-back (EFNBACK) task, that is an n-back task with high (2-back) and low (0-back) memory load conditions flanked by two positive, negative or neutral face distracters. This paradigm examines executive control with emotional distracters-emotion regulation. High memory load with neutral face distracters elicited greater bilateral and left dorsal anterior midcingulate cortex (dAMCC) activity in UDd than in healthy and BDId females respectively, and greater bilateral putamen activity in both depressed groups versus healthy females. High memory load with happy face distracters elicited greater left putamen activity in UDd than in healthy females. Psychotropic medication was associated with greater putamen activity to these contrasts in UDd females. During high memory load with neutral face distracters, elevated dAMCC activity in UDd suggests abnormal recruitment of attentional control circuitry to maintain task performance, whereas elevated putamen activity unrelated to psychotropic medication in BDId females may suggest an attentional bias toward ambiguous neutral face distracters. Differential patterns of functional abnormalities in neural circuitry supporting attentional control during emotion regulation, especially in the dAMCC, is a promising neuroimaging measure to distinguish UDd from BDId in females.

Abnormal prefrontal activity subserving attentional control of emotion in remitted depressed patients during a working memory task with emotional distracters

Patients with major depressive disorder (MDD) show deficits in processing of facial emotions that persist beyond recovery and cessation of treatment. Abnormalities in neural areas supporting attentional control and emotion processing in remitted depressed (rMDD) patients suggests that there may be enduring, trait-like abnormalities in key neural circuits at the interface of cognition and emotion, but this issue has not been studied systematically. Nineteen euthymic, medication-free rMDD patients (mean age 33.6 years; mean duration of illness 34 months) and 20 age- and gender-matched healthy controls (HC; mean age 35.8 years) performed the Emotional Face N-Back (EFNBACK) task, a working memory task with emotional distracter stimuli. We used blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to measure neural activity in the dorsolateral (DLPFC) and ventrolateral prefrontal cortex (VLPFC), orbitofrontal cortex (OFC), ventral striatum and amygdala, using a region of interest (ROI) approach in SPM2. rMDD patients exhibited significantly greater activity relative to HC in the left DLPFC [Brodmann area (BA) 9/46] in response to negative emotional distracters during high working memory load. By contrast, rMDD patients exhibited significantly lower activity in the right DLPFC and left VLPFC compared to HC in response to positive emotional distracters during high working memory load. These effects occurred during accurate task performance. Remitted depressed patients may continue to exhibit attentional biases toward negative emotional information, reflected by greater recruitment of prefrontal regions implicated in attentional control in the context of negative emotional information.

Impact of emotion on cognition in trauma survivors: What is the role of posttraumatic stress disorder?

Background Cognitive theories of anxiety disorders postulate an increased attentional bias to environmental cues associated with threat that underlies the exaggerated fear response. The role of trauma, which may represent strong competitive advantage for attention, remains unclear. We investigated the influence of trauma exposure and the presence of anxiety/stress disorders on the impact of emotional distractors on cognitive performance. Methods Fourteen trauma-exposed subjects with PTSD, 12 trauma-exposed subjects with anxiety disorders other than PTSD, 12 trauma-exposed healthy subjects and 19 non-trauma-exposed healthy controls participated in this study. The impact of emotion on cognition was determined by the Affective Stroop task that measures the effect of irrelevant emotional distractors on the speed of operant responding. Results The speed of cognitive performance was significantly reduced in the presence of negative distractors versus neutral or positive distractors in subjects with PTSD, while there was no significant influence of the distractor type on performance in the other diagnostic groups (diagnosis-by-distractor type interaction, p < 0.001). While negative distractors induced the same levels of anxiety and depersonalization in subjects with PTSD and subjects with other anxiety disorders, distractor-induced depersonalization was associated with slowing of cognitive performance in PTSD ( p = 0.02) but not in other groups. Limitations Different types of anxiety disorders in the non-PTSD group might reduce the selectivity of the results; some subjects received medication possibly impacting on their cognitive functioning. Conclusions The cognitive impairments in the presence of negative distractors specifically found in PTSD call for research into novel psychotherapeutic approaches, e.g. attentional training, for PTSD.

Deficits in attention to emotional stimuli distinguish youth with severe mood dysregulation from youth with bipolar disorder.

Studying attention in the context of emotional stimuli may aid in differentiating pediatric bipolar disorder (BD) from severe mood dysregulation (SMD). SMD is characterized by chronic irritability, arousal, and hyper-reactivity; SMD youth frequently receive a BD diagnosis although they do not meet DSM-IV criteria for BD because they lack manic episodes. We compared 57 BD (14.4 +/- 2.9 years old, 56% male), 41 SMD (12.6 +/- 2.6 years old, 66% male), and 33 control subjects (13.7 +/- 2.5 years old, 52% male) using the Emotional Interrupt task, which examines how attention is impacted by positive, negative, or neutral distracters. We compared reaction time (RT) and accuracy and calculated attention interference scores by subtracting performance on neutral trials from emotional trials. Between-group analyses indicated that SMD subjects had significantly reduced attention interference from emotional distracters relative to BD and control subjects. Thus, attention in SMD youth was not modulated by emotional stimuli. This blunted response in SMD youth may contribute to their affective and behavioral dysregulation.

Playing TETRIS for science counter-regulatory affective processing in a motivationally “hot” context

We adapted the computer game TETRIS to investigate the process of affective-motivational counter-regulation, that is, attentional biases for emotional stimuli that are in opposition to the momentary motivational focus. Counter-regulation is seen as a mechanism which should prevent escalation and impulsivity, and it should help to avoid becoming “locked up” in affective-motivational states. Accordingly, for a negative outcome focus condition (i.e., risk of losing a current high score), we hypothesized greater interference by positive distractors that were included in the game, whereas for a positive outcome focus (i.e., chance to improve one’s current high score), we hypothesized greater interference by negative distractors. Supporting our hypotheses, we found the predicted interactions between distractor valence and type of outcome focus.

The interference of operant task performance by emotional distracters: An antagonistic relationship between the amygdala and frontoparietal cortices

This fMRI study investigates neural activity associated with the interfering effects of emotional distracters. While in the scanner, participants made simple motor responses to target stimuli that were preceded and followed by positive, negative, or neutral images. Despite instructions to disregard the pictorial images, participants were slower to respond in the presence of positive or negative relative to neutral distracters, and significantly slower for negative relative to positive distracters. Enhanced activity in the amygdala and visual cortex was evident during trials that included positive and negative distracters. In contrast, increased activity in inferior frontal gyrus (BA 47) was only observed during trials that involved negative distracters. Connectivity analysis showed that activity in right amygdala correlated with activity in cingulate gyrus, posterior cingulate, middle temporal cortex, and was negatively correlated with activity in lateral superior frontal gyrus, middle frontal/orbital gyrus, and parietal cortex. The pattern of neural activity observed was interpreted within the framework of current cognitive models of attention. During a task demonstrating behavioural interference in the context of emotional distracters, increased activity in neural regions implicated in emotional processing (the amygdala) was associated with reduced activity in regions thought to be involved in exerting attentional control over task-relevant sensory representations (a frontoparietal network).

Biased emotional attention in post-traumatic stress disorder: a help as well as a hindrance?

From a cognitive neuroscience perspective, the emotional attentional bias in post-traumatic stress disorder (PTSD) could be conceptualized either as emotional hyper-responsiveness or as reduced priming of task-relevant representations due to dysfunction in 'top-down' regulatory systems. We investigated these possibilities both with respect to threatening and positive stimuli among traumatized individuals with and without PTSD. Twenty-two patients with PTSD, 21 trauma controls and 20 non-traumatized healthy participants were evaluated on two tasks. For one of these tasks, the affective Stroop task (aST), the emotional stimuli act as distracters and interfere with task performance. For the other, the emotional lexical decision task (eLDT), emotional information facilitates task performance. Compared to trauma controls and healthy participants, patients with PTSD showed increased interference for negative but not positive distracters on the aST and increased emotional facilitation for negative words on the eLDT. These findings document that hyper-responsiveness to threat but not to positive stimuli is specific for patients with PTSD.

Valence of distractor words increases the effects of irrelevant speech on serial recall

Participants memorized target words in silence or while ignoring neutral or valent (positive or negative) distractor words that could be either possessor-relevant or other-relevant. Distractor words impaired recall performance, but valent distractor words caused more disruption than neutral distractors, and negative distractors caused more disruption than positive distractors. The results are problematic for explanations of the irrelevant speech effect within working memory models that do not specify an explicit role of attention in the maintenance of information for immediate serial recall.

Alexithymia and incidental learning of emotional words.

Alexithymia is thought to reflect a deficit in the cognitive capacity to process emotions. Prior research suggests that emotional valence has a memory enhancing effect in poor conceptual learning conditions. This study addressed the question of whether incidental learning of emotional words is a function of alexithymic tendencies. Incidental learning is unintentional learning that results from other activities. The 20-item Toronto Alexithymia Scale (TAS-20) and measures of depression and verbal intelligence were administered to 30 nonclinical subjects (15 women, 15 men) whose mean age was 35.5 yr. (SD = 8.6) along with a sequential word-word evaluation task. Partial correlations indicated that the TAS-20 subscale, Difficulties identifying feelings was negatively correlated with recall of positive distractor words but not with recall of neutral distractors or recall of positive or negative target words. Emotional valence appears to have less organizational power in the memory of individuals with difficulties in recognizing their feelings.

Depression and mental control: The resurgence of unwanted negative thoughts.

In three experiments we examined depressed individuals' mental control abilities and strategies. Experiment 1 revealed that although depressed college students were initially successful in suppressing negative material, they eventually experienced a resurgence of unwanted negative thoughts. Analysis of subjects' stream-of-consciousness reports indicated that this resurgence was associated with the use of negative thoughts as distracters from the unwanted item. In Experiment 2 depressed subjects acknowledged that positive distracters were more effective than negative ones in suppressing negative thoughts. This acknowledgement suggests that depressed subjects in Experiment 1 did not deliberately focus on negative distracters but that those thoughts automatically occurred because they were highly accessible. Experiment 3 demonstrated that depressed subjects' use of positive distracters could be increased somewhat when we provided such distracters and made them easily accessible. Taken together, the findings suggest that depression involves an enhanced accessibility of interconnected negative thoughts that can undermine mental control efforts.