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Distorted Cognitive Processes in Major Depression: A Predictive Processing Perspective

  • Tobias Kube
    Correspondence
    Address correspondence to Tobias Kube, Ph.D., Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Ostbahnstrasse 10, Landau 76829, Germany.
    Affiliations
    Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany

    Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany

    Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Rainer Schwarting
    Affiliations
    Department of Behavioral Neuroscience, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
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  • Liron Rozenkrantz
    Affiliations
    Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts

    Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
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  • Julia Anna Glombiewski
    Affiliations
    Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany

    Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
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  • Winfried Rief
    Affiliations
    Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
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      Abstract

      The cognitive model of depression has significantly influenced the understanding of distorted cognitive processes in major depression; however, this model’s conception of cognition has recently been criticized as possibly too broad and unspecific. In this review, we connect insights from cognitive neuroscience and psychiatry to suggest that the traditional cognitive model may benefit from a reformulation that takes current Bayesian models of the brain into account. Appealing to a predictive processing account, we explain that healthy human learning is normally based on making predictions and experiencing discrepancies between predicted and actual events or experiences. We present evidence suggesting that this learning mechanism is distorted in depression: current research indicates that people with depression tend to negatively reappraise or disregard positive information that disconfirms negative expectations, thus resulting in sustained negative predictions and biased learning. We also review the neurophysiological correlates of such deficits in processing prediction errors in people with depression. Synthesizing these findings, we propose a novel mechanistic model of depression suggesting that people with depression have the tendency to predominantly expect negative events or experiences, which they subjectively feel confirmed due to reappraisal of disconfirming evidence, thus creating a self-reinforcing negative feedback loop. Computationally, we consider too much precision afforded to negative prior beliefs as the main candidate of pathology, accompanied by an attenuation of positive prediction errors. We conclude by outlining some directions for future research into the understanding of the behavioral and neurophysiological underpinnings of this model and point to clinical implications of it.

      Keywords

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      Linked Article

      • Can a Predictive Processing Framework Improve the Specification of Negative Bias in Depression?
        Biological PsychiatryVol. 87Issue 5
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          Our understanding of the psychological mechanisms underpinning depression was transformed by Aaron Beck’s 1979 cognitive model (1). Beck conceptualized the role of negative self-beliefs or schemata in depression, driving negative biases in information processing, and thereby maintaining the diverse symptoms seen in the disorder. These ideas have remained influential to this day. This model formed the basis for the development of psychological treatments such as cognitive behavioral therapy and shaped subsequent research and work in this area.
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