A Hot-Cold Cognitive Model of Depression: Integrating the Neuropsychological Approach Into the Cognitive Theory Framework

Abstract

In the 50 years following Beck’s cognitive theory, empirical research has consistently supported the role of dysfunctional, ‘hot’ cognition in the onset and maintenance of major depressive disorder. Compromised ‘cold’ cognition in attention, memory, and executive control abilities, independent of the affective state, has attracted much clinical interest for its role throughout the course of illness and into remission. We propose integrating cold cognition into Beck’s cognitive theory framework to account for the complementary roles of both hot and cold cognition in depression onset and maintenance. A critical review of cognitive research was conducted to inform an integrated hot-cold cognitive model of depression. Cold cognitive deficits likely act as a gateway to facilitate the activation and expression of the hot cognitive biases through a weakened ability to attend, retrieve, and critically assess information. Cold deficits become exacerbated by the negative mood state, essentially ‘becoming hot’, lending to maladaptive emotion regulation through ruminative processes. Depleted cognitive resources contribute to the manifestation of further deficit in problem-solving ability in everyday life, which in itself, may act as a stressor for the onset of recurrent episodes, perpetuating the depressive cycle. We discuss the interaction between hot and cold cognition within the cognitive theory framework and the potential of complementary hot-cold pathways to elucidate novel means of prevention and treatment for depression. Dysfunction in hot (emotion-dependent) and cold (emotion-independent) cognition has been demonstrated in depression, but psychological treatment has largely focused on hot cognition only. Hot and cold cognition are complementary processes throughout the activation and maintenance of depressive schemas and biases, necessitating the consideration of both hot and cold cognitive aspects to disrupt the depressive cycle. The proposed hot-cold cognitive model shows promise to stimulate new research avenues for the prevention and treatment of depression. Dysfunction in hot (emotion-dependent) and cold (emotion-independent) cognition has been demonstrated in depression, but psychological treatment has largely focused on hot cognition only. Hot and cold cognition are complementary processes throughout the activation and maintenance of depressive schemas and biases, necessitating the consideration of both hot and cold cognitive aspects to disrupt the depressive cycle. The proposed hot-cold cognitive model shows promise to stimulate new research avenues for the prevention and treatment of depression.

The Effects of Repetitive Transcranial Magnetic Stimulation Antidepressant Response on Cold Cognition: A Single-Arm Prospective Longitudinal Study

“…2 Although the disorder is characterized by depressed mood, the role of cognitive deficits in the development and maintenance of depression pathophysiology has been increasingly recognized. [3][4][5] Cognitive impairments have been associated with therapeutic response, risk of relapse, quality of life and occupational outcomes and remained, at least partially, present in remitted subjects. 6,7 The cognitive neuropsychological model of depression conceptualizes cognitive deficits as two systems including cold and hot cognition that rely on distinct, but interacting brain circuits.…”

“…13 Cold cognition can be affected by hot cognition through catastrophic responses to feedback and rumination at the cost of engaging with the external world. 3,13 Additionally, due to impaired top-down control of the cognitive control network on the DMN, negatively biased thoughts have "free reign" and may self-reinforce negative cognitive schemata by primarily drawing attention to emotion-eliciting details or appraisals that are congruent with negative expectations and beliefs. [3][4][5] In other words, the combination of attenuated top-down cognitive control and increased bottom-up emotional processing can be mutually reinforcing and perpetuate depressive symptoms.…”

“…3,13 Additionally, due to impaired top-down control of the cognitive control network on the DMN, negatively biased thoughts have "free reign" and may self-reinforce negative cognitive schemata by primarily drawing attention to emotion-eliciting details or appraisals that are congruent with negative expectations and beliefs. [3][4][5] In other words, the combination of attenuated top-down cognitive control and increased bottom-up emotional processing can be mutually reinforcing and perpetuate depressive symptoms. 3 Based on this theoretical framework, it has been suggested that remediation of cognitive impairments may be a valuable treatment target for depression.…”

“…[3][4][5] In other words, the combination of attenuated top-down cognitive control and increased bottom-up emotional processing can be mutually reinforcing and perpetuate depressive symptoms. 3 Based on this theoretical framework, it has been suggested that remediation of cognitive impairments may be a valuable treatment target for depression. 4,6 A treatment that has shown both enhancing effects on cognition 14,15 and antidepressant effects is repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex.…”

Protocol Across study: longitudinal transdiagnostic cognitive functioning, psychiatric symptoms, and biological parameters in patients with a psychiatric disorder

“…For instance, patients with schizophrenia have expressed a particular desire to treat cognitive deficits above the amelioration of their psychotic symptoms in order to function in daily life [8]. Cognitive deficits can also have an impact on other dimensions of psychiatric disorders by potentially contributing to and exacerbating cognitive biases [9]. However, cognitive dysfunction continues to be ineffectively treated because evidence-based treatments for cognitive dysfunction are scarce.…”