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Attentional Control in Subclinical Anxiety and Depression: Depression 2 Symptoms Are Associated with Deficits in Target Facilitation, Not 3 Distractor Inhibition

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Attentional Control in Subclinical Anxiety and Depression: Depression 2 Symptoms Are Associated with Deficits in Target Facilitation, Not 3 Distractor Inhibition 1 Attentional control in subclinical anxiety and depression: depression 2 symptoms are associated with deficits in target facilitation, not 3 distractor inhibition 4 Short title: Subclinical anxiety/depression and attentional target facilitation 5 Pike, Alexandra C.*1,2, Printzlau, Frida A.B.*3, von Lautz, Alexander, H.4 6 Harmer, Catherine J.1,5, Stokes, Mark G.3, Noonan, MaryAnn P.3 7 1Department of Psychiatry, University of Oxford, Oxford, UK 8 2Institute of Cognitive Neuroscience, University College London, London, UK 9 3Department of Experimental Psychology, University of Oxford, Oxford, UK 10 4Bernstein Center for Computational Neuroscience, Berlin, Germany 11 5Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford 12 *Joint contribution 13 Corresponding author: MaryAnn Noonan, Department of Experimental Psychology, 14 University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock 15 Road, Oxford, OX2 6HG, UK; [email protected] 16 Note that the task data we present has been previously analysed in Noonan et al. 2016, 17 Journal of Neuroscience. However, the relationships between these measures and the 18 self-report questionnaire scores that we report here are completely novel. 19 1 20 Attentional control in subclinical anxiety and depression: depression 21 symptoms are associated with deficits in target facilitation, not 22 distractor inhibition 23 Mood and anxiety disorders are associated with deficits in attentional control 24 involving emotive and non-emotive stimuli. Current theories focus on impaired 25 attentional inhibition of distracting stimuli in producing these deficits. However, 26 standard attention tasks struggle to separate distractor inhibition from target 27 facilitation. Here, we investigate whether distractor inhibition underlies these 28 deficits using neutral stimuli in a behavioural task specifically designed to tease 29 apart these two attentional processes. Healthy participants performed a four- 30 location Posner cueing paradigm and completed self-report questionnaires 31 measuring depressive symptoms and trait anxiety. Using regression analyses, we 32 found no relationship between distractor inhibition and mood symptoms or trait 33 anxiety. However, we find a relationship between target facilitation and 34 depression. Specifically, higher depressive symptoms were associated with 35 reduced target facilitation in a task-version in which the target location repeated 36 over a block of trials. We suggest this may relate to findings previously linking 37 depression with deficits in predictive coding in clinical populations. 38 Keywords: attention, anxiety, depression, attentional bias, target facilitation 39 Contribution to the field 40 Attentional biases in anxiety and depression are often interpreted as failures to inhibit 41 threat-based or mood-congruent stimuli. Further, research has also found that these 42 deficits are also evident in attentional paradigms using mood-neutral stimuli, suggesting a 43 general attentional impairment. However, previous studies have used tasks that struggle 44 to dissociate inhibition of distractors from target facilitation. In a previous study we 45 developed a paradigm to tease apart these two attentional components and demonstrated 46 they rely on different neural mechanisms. Here, we test the implications of this 47 dissociation for understanding attentional deficits in mood disorders. Explicitly, we test 48 the hypothesis that impairments in attention result from difficulties in inhibiting 49 distracting information. Contrary to expectations we found no relationship between 50 distractor inhibition and levels of self-reported depression and anxiety symptoms. 51 However, we did find a relationship between target facilitation and self-report depression; 52 with impairments in target facilitation linked to elevated depression symptoms in a task- 2 53 version where the stimulus location repeated throughout a block. We argue that findings 54 in previous studies may have been limited by confounding the effects of target facilitation 55 and distractor inhibition. Our results highlight the importance of dissociating these 56 component mechanisms of attentional control. 57 58 Introduction 59 Attention is a core cognitive mechanism for optimising information processing and 60 failures of attentional control over emotive as well as non-emotive stimuli are 61 consistently found in mood and anxiety disorders (Bar-Haim et al., 2007; Eysenck et al., 62 2007; Marazziti et al., 2010; McDermott & Ebmeier, 2009; Peckham et al., 2010; Shi et 63 al., 2019). Failures of attention can be attributed to several component mechanisms (e.g. 64 facilitation of goal-relevant information and/or inhibition of distractors) and 65 disentangling their relative contribution to failures of attention in mood and anxiety 66 disorders may be critical in understanding the aetiology and developing effective 67 treatments (Clarke et al., 2013). Here, we use a novel cognitive paradigm using mood- 68 neutral stimuli to quantify two dissociable attentional mechanisms: target facilitation 69 and distractor inhibition (Noonan et al., 2016). Here, we specifically test whether these 70 two component mechanisms of general attention are related to mood-relevant traits: 71 anxiety and depression. 72 73 Attentional bias (towards threat-related or negative information) is one of the key 74 cognitive markers in both major depressive disorder and anxiety disorders (Bar-Haim et 75 al., 2007; Peckham et al., 2010), and may contribute to the development and/or 76 maintenance of these disorders (Disner et al., 2017; Van Bockstaele et al., 2014). 77 Additionally, an increasing body of literature suggests attentional deficits in mood and 78 anxiety disorders are not always specific to emotive or disorder-relevant stimuli (‘hot 79 cognition’), but may reflect more general impairments in ‘cold cognition’ including 3 80 attentional control (Bishop, 2009; Eysenck et al., 2007; Fox, 1994; Marazziti et al., 81 2010; McDermott & Ebmeier, 2009; Roiser & Sahakian, 2013). 82 83 However, attentional control is multi-faceted, with distinctions drawn between 84 attentional engagement (initial attentional capture), disengagement (removing attention) 85 and switching (altering the focus of attention between stimuli). Failures of attention in 86 mood and anxiety disorders have often been interpreted as particularly related to 87 difficulties in inhibiting distractors. For example, the classic Posner cueing paradigm 88 has been used to disentangle component mechanisms of attentional biases in subclinical 89 anxious and depressed individuals and suggest a selective impairment in disengaging 90 from threat, as opposed to attentional engagement or switching (Koster et al., 2005; 91 Yiend & Mathews, 2001), but cf. (Koster et al., 2006). Similarly, studies investigating 92 deficits in ‘cold cognition’ have specifically linked anxiety and depression 93 symptomatology to deficits in distractor inhibition or disengagement, using paradigms 94 such as the antisaccade task (Ansari & Derakshan, 2011; De Lissnyder et al., 2011; 95 Derakshan et al., 2009) negative priming (Fox, 1994; MacQueen et al., 2000) the 96 flanker task (Bishop, 2009; Dillon et al., 2015), and visual search (Moran, 2016; Moran 97 & Moser, 2015). While not necessarily always to be expected, in many cases the deficits 98 in cold cognition mirror deficits observed under emotional contexts. For example, 99 Moran and Moser (2015) showed behavioural slowing in trait-anxious participants in a 100 visual search task using non-emotive distractor stimuli; echoing Rinck et al. (2003) who 101 found individuals with higher trait-anxiety had slower search times to disorder-relevant 102 distractor words. 103 4 104 However, increased distraction need not arise because of failures to directly 105 suppress distractors themselves, but could also arise due to failures of the target to 106 maintain its goal-relevant status. Standard attentional tasks, as those mentioned above, 107 struggle to disentangle inhibitory distractor processing from facilitation of target 108 processing (Leber et al., 2016; Noonan et al., 2016). Recently, Noonan et al. (2016) 109 showed that distractor inhibition is not under the same flexible top-down control as 110 target facilitation. In a four-location variant of the Posner cueing paradigm, we cued 111 participants to the spatial position of a target, the spatial position of a distractor or given 112 no informative cue. While target cues resulted in faster target discrimination regardless 113 of whether the target location varied flexibly on a trial-wise basis or was fixed for a 114 block of trials, distractor cues were only effective when the distractor location was fixed 115 and repeated over a block of trials. Furthermore, flexible target facilitation and 116 distractor inhibition did not correlate between participants, suggesting they rely on 117 distinct cognitive mechanisms. These findings may have implications for interpreting 118 deficits of distractor inhibition during attentional disengagement in mood disorders, as it 119 raises the alternative possibility that impairments are instead a failure to maintain and 120 focus on current goals (target facilitation), particularly in the presence of competition 121 (distractors). Such a hypothesis may account for the general slowing of patients’ 122 reaction times (Eysenck et al., 2007; Marazziti et al., 2010). 123 124 In the present study, we use non-emotive stimuli within
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