Emotion Regulation as a Mediator in the Relationship Between Cognitive Biases and Depressive Symptoms in Depressed, At-risk and Healthy Children and Adolescents

Abstract

Contemporary cognitive models of depression propose that cognitive biases for negative information at the level of attention (attention biases; AB) and interpretation (interpretation biases; IB) increase depression risk by promoting maladaptive emotion regulation (ER). So far, empirical support testing interactions between these variables is restricted to non-clinical and clinical adult samples. The aim of the current study was to extend these findings to a sample of children and adolescents. This cross-sectional study included 109 children aged 9–14 years who completed behavioural measures of AB (passive-viewing task) and IB (scrambled sentences task) as well as self-report measures of ER and depressive symptoms. In order to maximize the variance in these outcomes we included participants with a clinical diagnosis of depression as well as non-depressed youth with an elevated familial risk of depression and non-depressed youth with a low familial risk of depression. Path model analysis indicated that all variables (AB, IB, adaptive and maladaptive ER) had a direct effect on depressive symptoms. IB and AB also had significant indirect effects on depressive symptoms via maladaptive and adaptive ER. These findings provide initial support for the role of ER as a mediator between cognitive biases and depressive symptoms and provide the foundations for future experimental and longitudinal studies. In contrast to studies in adult samples, both adaptive as well as maladaptive ER mediated the effect of cognitive biases on depressive symptoms. This suggests potentially developmental differences in the role of ER across the lifespan.

Do markers of daily affect mediate associations between interpretation bias and depressive symptoms? A longitudinal study of early adolescents

“…In contrast to negative affect intensity, our nonsignificant findings for negative affect instability are somewhat unexpected based on work in adults (Puccetti et al, 2020) and prior research demonstrating associations between interpretation biases and trait emotion regulation (e.g., Sfärlea et al, 2021). First, discrepancies with Puccetti and colleagues (2020) may reflect developmental differences in the mechanisms underlying markers of daily affect in adults compared to early adolescents.…”

“…This possibility is supported by related work on emotion regulation. Negative interpretations of ambiguity have been linked to the use of maladaptive emotion regulation strategies (e.g., brooding; Everaert, Grahek, et al, 2017; Wilson et al, 2006), which has been shown to mediate associations between more negative interpretation biases and greater depressive symptoms (Blanco et al, 2021; Sfärlea et al, 2021). Automatic and inflexible interpretations may also facilitate further mood‐congruent cognitions, thereby impairing the efficacy of more adaptive strategies such as cognitive reappraisal.…”

“…In keeping with our dimensional approach and with studies indicating that depression is best conceptualized as a continuous construct (e.g., Hankin et al, 2005; Liu, 2016), depressive symptoms were examined along a continuum. Based on cognitive theories of depression (Beck, 1967; Joormann & Quinn, 2014) and work on trait emotion regulation (e.g., Sfärlea et al, 2021), we hypothesized that positive and negative affect intensity and instability would mediate prospective associations between negative interpretation biases at baseline and changes in depressive symptoms.…”

Social interpretation inflexibility moderates emotional reactions to social situations in children and adolescents

“…Multiple studies of adolescent depression and social anxiety support the adverse effect of interpretation biases on emotional experiences. Adolescents with depression or anxiety select more negative interpretations and fewer positive ones, across several different tasks (Haller et al, 2016; Lau & Waters, 2017; Leigh & Clark, 2018; Mobach et al, 2019; Oliver et al, 2019; Sfärlea et al, 2021; Stuijfzand et al, 2018). Preliminary evidence suggests that these biases are not merely consequences of depression or anxiety.…”

The antidepressant effect of cognitive reappraisal training on individuals cognitively vulnerable to depression: Could cognitive bias be modified through the prefrontal–amygdala circuits?

“…Frequent use of CR can modify an individual’s interpretation bias, dampen rumination bias, and thus alleviate depression symptoms (attention bias→interpretation bias→CR→rumination→depressive symptoms) ( Everaert et al, 2017 ). CR frequency mediated the relationship between interpretation biases and depressive symptoms in individuals at high familial risk for depression and alleviated the negative impact of interpretation bias on depressive symptoms (interpretation bias→CR→depressive symptoms) ( Sfärlea et al, 2021 ). Depression-resilient individuals tend to use CR to assign a new emotional meaning to stressful events ( Knyazev et al, 2017 ), whereas adolescents with parents having a history of depression (depression-vulnerable individuals) who frequently use CR as an emotion regulation strategy will experience less depression and have higher positive emotions ( Kudinova et al, 2018 ).…”