Depressive symptoms and visual attention to others' eyes in healthy individuals.

BACKGROUND: Eye contact is a fundamental part of social interaction. In clinical studies, it has been observed that patients suffering from depression make less eye contact during interviews than healthy individuals, which could be a factor contributing to their social functioning impairments. Similarly, results from mood induction studies with healthy persons indicate that attention to the eyes diminishes as a function of sad mood. The present screen-based eye-tracking study examined whether depressive symptoms in healthy individuals are associated with reduced visual attention to other persons' direct gaze during free viewing. METHODS: Gaze behavior of 44 individuals with depressive symptoms and 49 individuals with no depressive symptoms was analyzed in a free viewing task. Grouping was based on the Beck Depression Inventory using the cut-off proposed by Hautzinger et al. (2006). Participants saw pairs of faces with direct gaze showing emotional or neutral expressions. One-half of the face pairs was shown without face masks, whereas the other half was presented with face masks. Participants' dwell times and first fixation durations were analyzed. RESULTS: In case of unmasked facial expressions, participants with depressive symptoms looked shorter at the eyes compared to individuals without symptoms across all expression conditions. No group difference in first fixation duration on the eyes of masked and unmasked faces was observed. Individuals with depressive symptoms dwelled longer on the mouth region of unmasked faces. For masked faces, no significant group differences in dwell time on the eyes were found. Moreover, when specifically examining dwell time on the eyes of faces with an emotional expression there were also no significant differences between groups. Overall, participants gazed significantly longer at the eyes in masked compared to unmasked faces. CONCLUSIONS: For faces without mask, our results suggest that depressiveness in healthy individuals goes along with less visual attention to other persons' eyes but not with less visual attention to others' faces. When factors come into play that generally amplify the attention directed to the eyes such as face masks or emotions then no relationship between depressiveness and visual attention to the eyes can be established.

Non-conscious processing of fear faces: a function of the implicit self-concept of anxiety.

BACKGROUND: Trait anxiety refers to a stable tendency to experience fears and worries across many situations. High trait anxiety is a vulnerability factor for the development of psychopathologies. Self-reported trait anxiety appears to be associated with an automatic processing advantage for threat-related information. Self-report measures assess aspects of the explicit self-concept of anxiety. Indirect measures can tap into the implicit self-concept of anxiety. METHODS: We examined automatic brain responsiveness to non-conscious threat as a function of trait anxiety using functional magnetic resonance imaging. Besides a self-report instrument, we administered the Implicit Association Test (IAT) to assess anxiety. We used a gender-decision paradigm presenting brief (17 ms) and backward-masked facial expressions depicting disgust and fear. RESULTS: Explicit trait anxiety was not associated with brain responsiveness to non-conscious threat. However, a relation of the implicit self-concept of anxiety with masked fear processing in the thalamus, precentral gyrus, and lateral prefrontal cortex was observed. CONCLUSIONS: We provide evidence that a measure of the implicit self-concept of anxiety is a valuable predictor of automatic neural responses to threat in cortical and subcortical areas. Hence, implicit anxiety measures could be a useful addition to explicit instruments. Our data support the notion that the thalamus may constitute an important neural substrate in biased non-conscious processing in anxiety.

Efficient visual search for facial emotions in patients with major depression.

BACKGROUND: Major depressive disorder has been associated with specific attentional biases in processing emotional facial expressions: heightened attention for negative and decreased attention for positive faces. However, using visual search paradigms, previous reaction-time-based research failed, in general, to find evidence for increased spatial attention toward negative facial expressions and reduced spatial attention toward positive facial expressions in depressed individuals. Eye-tracking analyses allow for a more detailed examination of visual search processes over time during the perception of multiple stimuli and can provide more specific insights into the attentional processing of multiple emotional stimuli. METHODS: Gaze behavior of 38 clinically depressed individuals and 38 gender matched healthy controls was compared in a face-in-the-crowd task. Pictures of happy, angry, and neutral facial expressions were utilized as target and distractor stimuli. Four distinct measures of eye gaze served as dependent variables: (a) latency to the target face, (b) number of distractor faces fixated prior to fixating the target, (c) mean fixation time per distractor face before fixating the target and (d) mean fixation time on the target. RESULTS: Depressed and healthy individuals did not differ in their manual response times. Our eye-tracking data revealed no differences between study groups in attention guidance to emotional target faces as well as in the duration of attention allocation to emotional distractor and target faces. However, depressed individuals fixated fewer distractor faces before fixating the target than controls, regardless of valence of expressions. CONCLUSIONS: Depressed individuals seem to process angry and happy expressions in crowds of faces mainly in the same way as healthy individuals. Our data indicate no biased attention guidance to emotional targets and no biased processing of angry and happy distractors and targets in depression during visual search. Under conditions of clear task demand depressed individuals seem to be able to allocate and guide their attention in crowds of angry and happy faces as efficiently as healthy individuals.

Implicit affectivity in clinically depressed patients during acute illness and recovery.

BACKGROUND: Clinical depression is characterized by high levels of negative affect (NA) and attenuated positive affect (PA). Psychological and pharmacological treatments have been shown to reduce NA and to enhance PA in depressed patients. Following dual-process models, two types of affect can be distinguished: explicit (or self-reported) affect, which is formed by conscious reflections, and implicit affect, which relates to automatic affective reactions. The present study was conducted to examine, for the first time, both implicit and explicit affectivity in patients suffering from acute depression. Moreover, changes in patients' implicit and explicit affectivity were investigated over the course of inpatient treatment. METHODS: Thirty-nine patients suffering from major depression and 39 healthy individuals participated in the study. Implicit affectivity was assessed using the Implicit Positive and Negative Affect Test. The explicit state and trait affectivity were measured by the Positive and Negative Affect Schedule. The level of depressive symptoms was assessed with the Beck Depression Inventory. Tests were administered to patients after admission and after 7 weeks of therapy, whereas healthy controls were investigated only once. We examined whether either comorbidity or antidepressant medication has an effect on affectivity. RESULTS: Patients with acute depression had lower implicit and explicit PA scores and higher implicit and explicit NA scores than the healthy controls. After treatment, patients' level of depression decreased significantly. At posttreatment, patients exhibited heightened implicit and explicit PA and diminished explicit trait NA. Independent of antidepressant medication and comorbidity, no significant change in implicit NA was observed over the course of treatment. Implicit NA was correlated with explicit NA in acute depression but not during recovery. CONCLUSIONS: Acute depression appears to be characterized by decreased implicit and explicit PA and increased implicit and explicit NA. After 7 weeks of treatment, depressed patients' implicit and explicit PA increased, and explicit trait NA decreased. No decrease in implicit NA and explicit state NA occurred over the course of treatment. Finally, it seems that in the state of acute depression, the interplay between the automatic and reflective systems could be increased for negative affectivity.

Recognizing and Looking at Masked Emotional Faces in Alexithymia.

Alexithymia is a clinically relevant personality construct characterized by difficulties identifying and communicating one's emotions and externally oriented thinking. Alexithymia has been found to be related to poor emotion decoding and diminished attention to the eyes. The present eye tracking study investigated whether high levels of alexithymia are related to impairments in recognizing emotions in masked faces and reduced attentional preference for the eyes. An emotion recognition task with happy, fearful, disgusted, and neutral faces with face masks was administered to high-alexithymic and non-alexithymic individuals. Hit rates, latencies of correct responses, and fixation duration on eyes and face mask were analyzed as a function of group and sex. Alexithymia had no effects on accuracy and speed of emotion recognition. However, alexithymic men showed less attentional preference for the eyes relative to the mask than non-alexithymic men, which was due to their increased attention to face masks. No fixation duration differences were observed between alexithymic and non-alexithymic women. Our data indicate that high levels of alexithymia might not have adverse effects on the efficiency of emotion recognition from faces wearing masks. Future research on gaze behavior during facial emotion recognition in high alexithymia should consider sex as a moderating variable.

Deployment of attention to facial expressions varies as a function of emotional quality-but not in alexithymic individuals.

Background: Alexithymia is a risk factor for emotional disorders and is characterized by differences in automatic and controlled emotion processing. The multi-stimulus free-viewing task has been used to detect increased negative and reduced positive attentional biases in depression and anxiety. In the present eye-tracking study, we examined whether lexical emotional priming directs attention toward emotion-congruent facial expressions and whether alexithymia is related to impairments in lexical priming and spontaneous attention deployment during multiple face perception. Materials and methods: A free-viewing task with happy, fearful, angry, and neutral faces shown simultaneously was administered to 32 alexithymic and 46 non-alexithymic individuals along with measures of negative affect and intelligence. Face presentation was preceded by masked emotion words. Indices of initial orienting and maintenance of attention were analyzed as a function of prime or target category and study group. Results: Time to first fixation was not affected by prime category or study group. Analysis of fixation duration yielded a three-way interaction. Alexithymic individuals exhibited no prime or target category effect, whereas non-alexithymic individuals showed a main effect of target condition, fixating happy faces longer than neutral and angry faces and fearful faces longer than angry faces. Discussion: Our results show evidence of attentional biases for positive and fearful social information in non-alexithymic individuals, but not in alexithymic individuals. The lack of spontaneous attentional preference for these social stimuli in alexithymia might contribute to a vulnerability for developing emotional disorders. Our data also suggest that briefly presented emotion words may not facilitate gaze orientation toward emotion-congruent stimuli.

Positive attentional bias mediates the relationship between trait emotional intelligence and trait affect.

Emotional intelligence and, in particular, the component emotion regulation may increase well-being and improve mood and coping with negative emotions. In the present eye-tracking study, we examined whether attention allocation to positive stimuli mediates the relationship between emotion regulation abilities and trait affect. Gaze behavior of 104 healthy adults was analyzed in a free-viewing task, in which happy, sad, angry, and neutral faces were shown simultaneously for ten seconds. Dwell time on facial expressions was used as indicator of attention allocation. Trait emotional intelligence was assessed using the Self-Rated Emotional Intelligence Scale. Self-report measures of state and trait positive and negative affect, trait anxiety, and depression were administered. In general, participants viewed longer at happy than at negative or neutral faces. The results of mediation analyses indicated that intrapersonal and interpersonal emotion regulation abilities were indirectly related to trait positive affect through attention to happy faces. Moreover, dwell time on happy faces had a mediating effect on the relationship between interpersonal emotion regulation ability and trait anxiety. Preference for positive social signals might form one attentional pathway through which emotion regulation abilities promote positive mood and buffer the development of anxiety reactions in everyday life.

Experiences of maltreatment in childhood and attention to facial emotions in healthy young women.

Using reaction-time measures, research on the relationship between childhood maltreatment and biased attention to emotional stimuli in adults has obtained inconsistent results. To help clarify this issue, we conducted an eye-tracking study on the link between childhood maltreatment and allocation of attention to facial emotions analyzing gaze behavior in addition to manual reactions. In contrast to prior investigations, we excluded individuals with tendencies to minimize maltreatment experiences from analyses. Gaze behavior and manual response time of 58 healthy women were examined in a dot-probe task in which pairs of emotional (happy, sad, or disgusted) and neutral faces were presented. In our analyses, participants' affectivity, level of alexithymia, and intelligence were controlled. Entry time and dwell time on facial expressions were used as indicators of attention allocation. Childhood maltreatment showed no effect on response latencies but was associated with shorter entry times on emotional faces and shorter dwell time on disgusted faces. Experiences of childhood maltreatment seem to be linked to an increased early vigilance to emotional social signals and to an attentional avoidance of hostile facial expressions at a later stage of perception. The present results suggest a vigilance-avoidance pattern of attention allocation associated with childhood maltreatment.

Coping With Anxiety: Brain Structural Correlates of Vigilance and Cognitive Avoidance.

Background: Individuals differ in their dispositional coping behavior when they are confronted with anxiety-provoking situations. Cognitive avoidance is characterized by a withdrawal from threatening information, whereas vigilance denotes the intensive search for threat-related information. Functional neuroimaging studies indicate alterations in brain responsivity to emotional stimuli as a function of cognitive avoidant and vigilant coping, but findings are partially discrepant. Studies on structural correlates of coping styles are scarce. Materials and Methods: By using structural magnetic resonance imaging, the present study examined the relationship between brain gray matter volume and coping strategies in 114 healthy individuals. Individual differences in vigilance and cognitive avoidance were measured by the Mainz Coping Inventory. Results: Exploratory whole-brain analyses were conducted. Cognitive avoidant coping significantly predicted reduced gray matter volume in the bilateral thalamus, whereas vigilant coping was associated with volumetric increases in the bilateral thalamus. These relationships remained significant when controlling for a potential influence of age, sex, depressive symptoms, and trait anxiety. Discussion: Our findings indicate that dispositional strategies to deal with anxiety-provoking situations are related to volumetric alterations in the thalamus, a brain structure that has been implicated in the mediation of attentional processes and alertness, and the anticipation of harm. The dispositional tendency to monitor the environment for potential threats (i.e., vigilance), appears to be associated with volumetric increases in the thalamus, whereas the dispositional inclination to divert one's attention away from distressing stimuli (i.e., cognitive avoidance) seems to go along with reductions in thalamic gray matter density.

Alexithymia Is Associated With Deficits in Visual Search for Emotional Faces in Clinical Depression.

Background: The concept of alexithymia is characterized by difficulties identifying and describing one's emotions. Alexithymic individuals are impaired in the recognition of others' emotional facial expressions. Alexithymia is quite common in patients suffering from major depressive disorder. The face-in-the-crowd task is a visual search paradigm that assesses processing of multiple facial emotions. In the present eye-tracking study, the relationship between alexithymia and visual processing of facial emotions was examined in clinical depression. Materials and Methods: Gaze behavior and manual response times of 20 alexithymic and 19 non-alexithymic depressed patients were compared in a face-in-the-crowd task. Alexithymia was empirically measured via the 20-item Toronto Alexithymia-Scale. Angry, happy, and neutral facial expressions of different individuals were shown as target and distractor stimuli. Our analyses of gaze behavior focused on latency to the target face, number of distractor faces fixated before fixating the target, number of target fixations, and number of distractor faces fixated after fixating the target. Results: Alexithymic patients exhibited in general slower decision latencies compared to non-alexithymic patients in the face-in-the-crowd task. Patient groups did not differ in latency to target, number of target fixations, and number of distractors fixated prior to target fixation. However, after having looked at the target, alexithymic patients fixated more distractors than non-alexithymic patients, regardless of expression condition. Discussion: According to our results, alexithymia goes along with impairments in visual processing of multiple facial emotions in clinical depression. Alexithymia appears to be associated with delayed manual reaction times and prolonged scanning after the first target fixation in depression, but it might have no impact on the early search phase. The observed deficits could indicate difficulties in target identification and/or decision-making when processing multiple emotional facial expressions. Impairments of alexithymic depressed patients in processing emotions in crowds of faces seem not limited to a specific affective valence. In group situations, alexithymic depressed patients might be slowed in processing interindividual differences in emotional expressions compared with non-alexithymic depressed patients. This could represent a disadvantage in understanding non-verbal communication in groups.

Attentional biases to emotional information in clinical depression: A systematic and meta-analytic review of eye tracking findings.

BACKGROUND: In the last decade, eye-tracking technology has been increasingly used to investigate attention orientation in depression. The aim of the current review was to summarize the available eye-tracking research specifying the effects of clinical depression on early and late attention allocation during visual perception of emotional material. METHODS: The literature search identified sixteen relevant publications, including twelve free-viewing studies in which multiple stimulus arrays with images (scenarios) or faces were administered. Meta-analyses were conducted to evaluate the impact of acute depression on attentional maintenance during free viewing as a function of type and emotional quality of stimulus material. RESULTS: Moderate (to large) differences were observed between depressed and healthy individuals in maintained attention to dysphoric images (Hedges' g = .66) and sad faces (g = .58). Moderate group differences were also revealed for maintained attention to positive images (g = -.51) and happy faces (g = -.54). Age of patients explained between study variance in effect sizes for attention to happy faces. No group differences in initial attention orientation were found. LIMITATIONS: The number of free-viewing studies based on images was low (n=4). CONCLUSIONS: Our results suggest that clinical depression is characterized by medium-sized increases of attention maintenance for dysphoric and medium-sized decreases for positive stimuli compared to healthy individuals. Therefore, both alterations represent equally important targets for attention modification programs. Depressed patients seem not to manifest abnormalities in early orienting to emotional stimuli. Differences between patients and healthy subjects in attention to positive stimuli may diminish with age.

The relationship between dispositional attention to feelings and visual attention to emotion.

Attention to feelings is a core dimension of individual differences in the perception of one's emotions. It concerns the frequency with which own emotions are attended to. The aim of the present eye-tracking investigation was to examine the relationship of dispositional attention to feelings with early and late attentional processes in the visual perception of emotional information. Attentional orientation was assessed in a sample of healthy women (N = 91) using eye-tracking during a free viewing task in which images with positive, negative and neutral content were shown simultaneously. Pictures were taken from the Besançon Affective Picture Set. State and trait affect, depression, and intelligence of participants were controlled. In our sample, attention to feelings was not related to positive affect, negative affect, depression or intelligence. Attention to feelings was negatively correlated with entry times for all emotional picture types. Moreover, attention to feelings was positively correlated with dwell time on positive images and negatively correlated with dwell time on neutral images. Our data indicate that devoting habitually attention to one's feelings is linked to an enhanced initial orientation of attention towards emotional scenes, irrespective of affective valence. Dispositional attention to feelings might also be associated with an attentional preference for emotional over neutral visual stimuli. The present findings on general individual differences in attention to feelings could have important implications for future clinical research on attentional biases.

Face perception without subjective awareness - Emotional expressions guide early gaze behavior in clinically depressed and healthy individuals.

BACKGROUND: Major depressive disorder is associated with attentional biases in the explicit processing of emotional facial expressions. It is unclear if attentional biases for emotional faces also exist at an automatic level of perception. METHOD: Gaze behavior of twenty-nine clinically depressed individuals and twenty-nine gender matched healthy controls was compared in an affective priming task. Happy, neutral, sad, angry, and fearful facial expressions were presented very briefly as primes with forward and backward masking, followed by a neutral expression. Participants' early gaze behavior on neutral faces was analyzed for the eyes and mouth as areas of interest. Only participants who were subjectively unaware of the emotional prime faces were included in the analyses. RESULTS: Masked emotional facial expressions elicited early eye movements toward diagnostic features of the face. Both, depressed patients and healthy controls oriented their initial fixation on the face more often to the eye region after the presentation of fearful or sad compared to happy primes. However, depressed patients oriented their gaze generally far less to the eye and mouth region compared to healthy controls. LIMITATION: Awareness of emotional prime faces was assessed by a systematic interview but not by an objective detection task. CONCLUSION: Our data suggest enhanced attentional orienting toward the eye region due to fearful and sad faces in depressed and healthy individuals. In spite of this early expression-specific vigilance, depressed individuals oriented their gaze overall less to the eyes and mouth compared to healthy controls, which might represent an avoidance of facial features.

Effects of Briefly Presented Masked Emotional Facial Expressions on Gaze Behavior: An Eye-Tracking Study.

Orientation of gaze toward specific regions of the face such as the eyes or the mouth helps to correctly identify the underlying emotion. The present eye-tracking study investigates whether facial features diagnostic of specific emotional facial expressions are processed preferentially, even when presented outside of subjective awareness. Eye movements of 73 healthy individuals were recorded while completing an affective priming task. Primes (pictures of happy, neutral, sad, angry, and fearful facial expressions) were presented for 50 ms with forward and backward masking. Participants had to evaluate subsequently presented neutral faces. Results of an awareness check indicated that participants were subjectively unaware of the emotional primes. No affective priming effects were observed but briefly presented emotional facial expressions elicited early eye movements toward diagnostic regions of the face. Participants oriented their gaze more rapidly to the eye region of the neutral mask after a fearful facial expression. After a happy facial expression, participants oriented their gaze more rapidly to the mouth region of the neutral mask. Moreover, participants dwelled longest on the eye region after a fearful facial expression, and the dwell time on the mouth region was longest for happy facial expressions. Our findings support the idea that briefly presented fearful and happy facial expressions trigger an automatic mechanism that is sensitive to the distribution of relevant facial features and facilitates the orientation of gaze toward them.

Attentional bias and childhood maltreatment in clinical depression - An eye-tracking study.

Major depressive disorder (MDD) has been found to be associated with biased attention to emotional stimuli: increased attention for dysphoric information and/or decreased attention for positive information compared to healthy individuals. A history of childhood maltreatment (CM) has been discussed as a factor that might have an impact on the occurrence and extent of biased attention in depression. The present study examined the association between CM and attention for facial emotions in currently depressed patients using eye-tracking methodology. In a free viewing paradigm, 31 individuals with MDD and 31 healthy subjects viewed images of four facial expressions (happy, sad, angry, and neutral). Dwell time on each facial expression was used as an indicator of attention allocation. Childhood maltreatment was assessed using the German version of the Childhood Trauma Questionnaire. Depressed patients showed shorter gaze durations for happy faces compared to healthy controls. This result is in line with the assumption that depression goes along with a loss of elaborative processing of positive stimuli. No group differences were observed concerning dwell times on negative faces. However, CM was associated with reduced attention for angry and sad facial expressions in the depressed sample. Depressed individuals with a history of CM seem to avoid processing of threatening or burdensome stimuli. Early life adversity appears to impact attention allocation in depressed individuals and might help to explain discordant results in the literature regarding biased attention to negative facial expressions in depression.

Implicit negative affect predicts attention to sad faces beyond self-reported depressive symptoms in healthy individuals: An eye-tracking study.

Cognitive theories of depression assume biased attention towards mood-congruent information as a central vulnerability and maintaining factor. Among other symptoms, depression is characterized by excessive negative affect (NA). Yet, little is known about the impact of naturally occurring NA on the allocation of attention to emotional information. The study investigates how implicit and explicit NA as well as self-reported depressive symptoms predict attentional biases in a sample of healthy individuals (N = 104). Attentional biases were assessed using eye-tracking during a free viewing task in which images of sad, angry, happy and neutral faces were shown simultaneously. Participants' implicit affectivity was measured indirectly using the Implicit Positive and Negative Affect Test. Questionnaires were administered to assess actual and habitual explicit NA and presence of depressive symptoms. Higher levels of depressive symptoms were associated with sustained attention to sad faces and reduced attention to happy faces. Implicit but not explicit NA significantly predicted gaze behavior towards sad faces independently from depressive symptoms. The present study supports the idea that naturally occurring implicit NA is associated with attention allocation to dysphoric facial expression. The findings demonstrate the utility of implicit affectivity measures in studying individual differences in depression-relevant attentional biases and cognitive vulnerability.