Attentional biases toward emotional images in the different episodes of bipolar disorder: An eye-tracking study

Abstract

a b s t r a c tAttentional biases toward emotional information may represent vulnerability and maintenance factors in bipolar disorder (BD). The present experimental study examined the processing of emotional information in BD patients using the eye-tracking technology. Bipolar patients in their different states (euthymia, mania, depression) simultaneously viewed four pictures with different emotional valence (happy, neutral, sad, threatening) for 20 s while their eye movements were monitored. A group of healthy individuals served as the control. The data revealed the following: (i) a decrease in attention to happy images in BD patients in their depressive episodes compared to healthy individuals, and (ii) an increase in attention to threatening images in BD patients (regardless of their episode) relative to the healthy controls. These biases appeared in the late stages of information processing and were sustained over the 20 s interval. Thus, the present findings reveal that attentional biases toward emotional information can be a key feature of BD, in that: (i) an anhedonic lack of sensitivity to positive stimuli during the bipolar depressive episode may be considered a maintaining factor of this clinical state, and (ii) the trait-bias toward threat, even in asymptomatic patients, may reflect a marker of vulnerability in BD.

A New Approach to Emotional Dysregulation in Bipolar Disorder

“…Importantly, unlike healthy individuals, BD patients (regardless of their episode) showed greater attention to threatening both in capture attention (i.e., number of first-pass fixations) and in overall allocation (i.e., number of total fixations). Taken together [8,9] findings strongly suggest that BD patients when freely attend to emotional stimuli show a bias towards threat-related information, even in early states of information processing. According to [10], threatening information may be emotionally relevant due to BD patients are usually characterized by psychotic and paranoid traits.…”

“…These differences were observed in the overall allocation of attention (i.e., percent fixation time and percent fixations) but not in ealier attentional capture (i.e., first-pass duration and location of the initial fixation). While these data from [8] are relevant to determine the interplay of the attentional biases in the different episodes of BD, there was a shortcoming: the simultaneous presence of multiple emotional stimuli impedes to know the effect on attention of each emotional stimulus. To assess separately the effect of each emotional stimulus, [9] presented simultaneously a target scene (happy, neutral, and threatening) together with a neutral control scene for 3s in a free-viewing task.…”

“…The cognitive model about unipolar depression cannot be directly extrapolated to BD for three reasons: a) unlike unipolar depression, an anhedonic lack of sensitivity to positive stimuli is more salient than a preference by negative stimuli in BD [8]; b) cognitive theories do not keep in mind the influence of threatening schemata in BD, which are present during free-viewing processing [8,9]; and c) unlike unipolar depression, the mood-congruent bias can also occur in the earliest stages of processing [7,9]. In addition, characterizing the components of attentional bias in BD is not only crucial for improving theoretical paradigms, but it is also essential for specifying treatment targets based on attention training, which have been showed effective in other mental disorders [11].…”

“…In the [8] experiment, BD patients were simultaneously viewed with four complex scenes with different emotional valence (happy, neutral, sad, threatening) for 20s while their eye movements were registered. BD patients, regardless of their episode, showed greater attention to threatening pictures than healthy individuals.…”

The Impact of Thought Speed and Variability on Psychological State and Threat Perception: Further Exploration of the Theory of Mental Motion

“…However, the evidence did not support this prediction. This study component was acknowledged as exploratory given the mixed evidence of threat sensitivity in mania (Carver and Johnson 2009;Garcia-Blanco et al 2014) and that existing interpretation bias research has predominantly focused on valence, not threat (e.g., Lex et al 2011;Thomas et al 2009). Consequently, the study results cannot be considered conclusive evidence that mania-consistent processing biases are not induced by manipulated changes in thought speed and variability.…”