1. Konstantinos G. Zeimpekis, MSc, DIC 22 November 2013 Attention, Emotion & Memory in Depression & Anxiety Basics and Definitions

2. Preview Cognitive Functions Anxiety and Depression Attention Emotion Memory Konstantinos Zeimpekis

3. Brain Imaging MR Diffusion Tensor Imaging Tractography PET scan Konstantinos Zeimpekis

4. Attention Frontal Lobe & Thalamus, Hypothalamus Konstantinos Zeimpekis

5. Memory Temporal lobe, Hippocampus, Amygdala, Basal Ganglia Konstantinos Zeimpekis

6. Emotion Amygdala Konstantinos Zeimpekis

7. Brain in Depression - limbic system  anterior cingulate cortex + dorsolateral prefrontal cortex difficulty recruiting brain regions for cognitive control Konstantinos Zeimpekis

8. Brain in Depression Konstantinos Zeimpekis

9. 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 Konstantinos Zeimpekis

10. Depression  Increased elaboration of negative information  Difficulty in disengaging from negative material  Deficits in cognitive control when negative information is processed. Konstantinos Zeimpekis

11. 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) Konstantinos Zeimpekis

12. Depression  MDD is characterized by negative automatic thoughts and biases in attention, interpretation and memory  Vulnerability stressor Konstantinos Zeimpekis

13. 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) Konstantinos Zeimpekis

14. Anxiety models panic disorder catastrophic interpretative bias social phobia focused attentional bias clinical depression negative attributional style and rumination GAD “worry about worry” Konstantinos Zeimpekis

15. 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) Konstantinos Zeimpekis

16. Emotion Dysregulation o difficulties disengaging from negative material o impaired emotion regulation Konstantinos Zeimpekis

17. 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 Konstantinos Zeimpekis

18. 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) Konstantinos Zeimpekis

19. 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 Konstantinos Zeimpekis

20. 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). Konstantinos Zeimpekis

21. 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) Konstantinos Zeimpekis

22. 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 mood- congruent stimuli Konstantinos Zeimpekis

23. 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) Konstantinos Zeimpekis

24. Attention Attention biases of depressed individuals are expected to endure beyond the depressive episode (Bower 1981) Konstantinos Zeimpekis

25. 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) Konstantinos Zeimpekis

26. 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 Konstantinos Zeimpekis

27. 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) Konstantinos Zeimpekis

28. 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 Konstantinos Zeimpekis

29. 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) Konstantinos Zeimpekis

30. 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) Konstantinos Zeimpekis

31. 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) Konstantinos Zeimpekis

32. 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 Konstantinos Zeimpekis

33. 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) Konstantinos Zeimpekis

34. Overgeneral Memory Overgenerality general memory deficits recalling contextual detail Overgeneral memory is a consistent characteristic of patients with a diagnosis of MDD Konstantinos Zeimpekis

35. 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 Konstantinos Zeimpekis

36. Overgeneral Memory Depression / Post Traumatic Stress Disorder Overgeneral Memories Negative experiences / trauma events retrieval Executive control Impairment Failure to inhibit competing information Konstantinos Zeimpekis

37. Journal Club Konstantinos Zeimpekis

38. Journal Club Emotion Konstantinos Zeimpekis Higher-order cognitive functions Inhibitory Control

39. Journal Club Konstantinos Zeimpekis

40. Journal Club Konstantinos Zeimpekis

41. Journal Club Konstantinos Zeimpekis

42. Journal Club Konstantinos Zeimpekis

43. Thank you !