On their own, both anxiety and depression can completely cripple an individual’s life, making it difficult for them to maintain education, work, and sometimes even social interactions1-2. To make matters worse, these disorders are often co-morbid or, in other words, co-occurring. In fact, one study estimates that more than 50% of patients diagnosed with depression also suffer from anxiety and vice versa3. These individuals seem to take a longer time to recover from their disorders, have higher rates of recurrence, and experience a greater negative impact on their day to day lives. Furthermore, it can become incredibly difficult to disentangle their effects and decide on the correct course of treatment.
The Chicken or The Egg?
For instance, if a patient comes in with symptoms of anxiety and depression, it could be that their anxiety started first and actually caused their depression. In which case, a therapist might try to treat the anxiety first as the source of depression. However, it could also be that their depression started first, resulting in them becoming anxious. In which case, a therapist might try to treat the depression first as the source of anxiety. Thus, developing a means of distinguishing between these disorders could help therapists better treat their clients.
Examining an individual’s attentional biases offers one way to potentially disentangle these disorders. Simply put, an attentional bias is a tendency to attend to certain information over other information. For example, when really hungry, you may find yourself inordinately distracted by food related words or images, and you may have a hard time thinking of anything other than food. Likewise, individuals with anxiety have a strong attentional bias towards threatening or emotionally negative information (e.g., images of violence, death)4-5. In other words, they find such information incredibly distracting and might have a hard time switching their attention away from threatening or negative imagery, in part due to deficits in executive functioning. Depressed individuals show a similar bias6 but to a much lesser degree than seen in anxious participants7. Given these differences, it is possible that researchers could develop a task that distinguishes between these disorders by examining an individual’s attentional biases.
A Study of Attentional Bias
In a recent study, Dr. Lichtenstein-Vidne of Ben-Gurion University of the Negev (Beer-Sheva, Israel) and her colleagues investigated a novel paradigm for distinguishing between the attentional biases of anxious, depressed, and healthy participants8. As mentioned above, previous studies have examined attentional biases related to these disorders; however, all of these studies presented the emotionally distracting information in the center of attention, making them a central part of the task. The researchers in the current study wanted to examine the role of such distractors when they were completely irrelevant to the task at hand. They argued that such a task would allow a true test of attentional biases toward distracting information.
For their study, the experimenters recruited individuals clinically diagnosed with an anxiety disorder (either generalized anxiety disorder, panic disorder, social phobia, or an unspecified anxiety disorder), major depressive disorder, and healthy individuals, without any mental illness. Participants kept their attention focused on the center of the screen, while target images were then presented either directly above or directly below the center. Participants indicated quickly as possible which location the image appeared in. At the same time, two distracting images, that were either positive (e.g., a smiling happy baby), neutral (e.g., a coffee mug), or negative (e.g., a violent car wreck), were presented on the either side of the screen, either at the top, the middle, or the bottom. Participants were instructed to ignore these images and only respond to the targets presented in the center of the screen.
The Study’s Findings
Overall, the researchers found that anxious individuals were significantly slower to respond to the target image when the distracting images were negative as opposed to when they were positive or neutral. Depressed and healthy participants demonstrated no such effect. In other words, anxious individuals seemed to have an attentional bias towards negative information, leading them to become distracted by such images, whereas depressed and healthy participants were not.
This finding provides strong evidence that anxious individuals have an attentional bias towards negative information and depressed individuals do not, at least when distractors are completely irrelevant to the task. In so doing, this study highlights a potential way for therapists to distinguish between these two disorders, which could lead to more targeted and more efficient treatment. Crucially, this work is still ongoing. As previously mentioned, some studies have found that depressed individuals do show an attentional bias towards negative information. Thus, future work will need to identify that exact scenarios where the two disorders diverge.
1. Mendlowicz, M. V., & Stein, M. B. (2000). Quality of life in individuals with anxiety disorders. American Journal of Psychiatry, 157(5), 669-682.
2. Pyne, J. M., Patterson, T. L., Kaplan, R. M., Gillin, J. C., Koch, W. L., & Grant, I. (1997). Assessment of the quality of life of patients with major depression. Psychiatric services.
3. Hirschfeld, R. M. (2001). The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Prim Care Companion J Clin Psychiatry, 3(6), 244-54.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
5. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133(1), 1.
6. Koster, E. H., Fox, E., & MacLeod, C. (2009). Introduction to the special section on cognitive bias modification in emotional disorders. Journal of Abnormal Psychology, 118(1), 1.
7. Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: current status and future directions. Annual review of clinical psychology, 6, 285.
8. Lichtenstein-Vidne, L., Okon-Singer, H., Cohen, N., Todder, D., Aue, T., Nemets, B., & Henik, A. (2016). Attentional bias in clinical depression and anxiety: the impact of emotional and non-emotional distracting information. Biological psychology.
Sam Hunley holds a doctorate in cognitive psychology from Emory University. He pursued his Bachelor's degree in psychology from Furman University and a master's from Emory. Sam's research, alongside Dr. Stella Lourenco, focuses on human perception of the space surrounding the body, exploring the impact of anxiety and phobias on this perception. Together, they contribute to Anxiety.org articles. Post-graduation, Sam became a Presidential Management Fellow.