Cognitive control biases in depression: A systematic review and meta-analysis

Abstract

Cognitive theories of depression propose that impaired cognitive control of emotional material may be involved in the onset, maintenance, and/or recurrence of depression. The present study is a systematic review and meta-analysis of the literature on cognitive control biases in depression. Seventy-three articles describing 77 independent studies (N = 4,134 participants) were included in the meta-analysis. Depression-vulnerable individuals, including individuals with diagnosed major depressive disorder (MDD), remitted MDD (rMDD), and dysphoria, showed significantly impaired cognitive control of negative stimuli relative to both neutral and positive stimuli. Control samples did not exhibit the aforementioned biases, and instead showed significantly worse cognitive control of positive stimuli relative to negative stimuli and similar cognitive control of neutral stimuli relative to both negative and positive stimuli. Evidence for sample or methodological moderators of effect sizes was limited and inconsistent. Based on our review, we recommend that researchers assess and examine directional and causal relationships between multiple cognitive control biases (especially in updating and set shifting), investigate the causal relationships between general deficits and biases in cognitive control, select tasks that control for nontarget influences on performance (e.g., processing speed), use sample sizes adequately powered to detect small effects, provide psychometric information on task indices, consistently report within-groups biases and between-groups comparisons of biases, and examine potential moderators of cognitive control biases at the individual level. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement: Public Significance Statement—This meta-analysis indicates that depression-vulnerable individuals, including individuals with current major depressive disorder, remitted MDD, and dysphoria, have impaired cognitive control of negative stimuli relative to neutral and positive stimuli. In contrast, healthy control individuals have worse cognitive control of positive stimuli relative to negative stimuli and similar cognitive control of neutral stimuli relative to both negative and positive stimuli. These biases in cognitive control are small but may lead to a preponderance of negative information in working memory for depression-vulnerable individuals and have implications for how negative moods are maintained. (PsycInfo Database Record (c) 2023 APA, all rights reserved)