You are on page 1of 6

Current Directions in Psychological

Cognitive Inhibition and Emotion 19(3) 161-166
The Author(s) 2010
Regulation in Depression Reprints and permission:
DOI: 10.1177/0963721410370293

Jutta Joormann
University of Miami

In this article I propose that cognitive inhibition is a key mechanism in the regulation of emotion and that deficits in inhibition of
negative material are related to increased risk for depression. Because negative mood yields activation of mood-congruent cogni-
tions in working memory (WM), the ability to control the contents of WM could be crucial in differentiating people who recover
easily from negative affect from those who initiate a vicious cycle of increasingly negative thinking and deepening sad mood.
Depressed people and people at risk for depression have trouble preventing negative material from entering and remaining in
WM, leading them to rehearse, or to ruminate about, negative content. Inhibition deficits may also interfere with reappraisal and
the recall of mood-incongruent material, further hindering recovery from negative affect. This article provides a brief summary of
findings that support these propositions and outlines implications for future research on the relation between inhibition and emo-
tion regulation and its role in depression.

depression, inhibition, cognition, emotion, emotion regulation

Studies investigating the interaction of cognition and emotion consists of the activation of mood-congruent representations in
have a long tradition in depression research. Cognitive theories working memory (Siemer, 2005). Thus, negative mood is
of depression propose that peoples thoughts, inferences, atti- related to more frequent negative thoughts, selective attention
tudes, and interpretations, and the ways they attend to and to negative stimuli, and greater accessibility of negative mem-
recall events determine their emotional states. Consequently, ories. This research has also shown, however, that such changes
cognitions play a crucial role in how much people are affected in cognition due to negative mood are usually transient; mood-
by negative experiences, determining whether these events will congruent cognitions are often replaced quite quickly by
be followed by quick recovery or by recurring depressive epi- thoughts and memories that serve to regulate and repair the
sodes. Whereas previous investigators focused primarily on mood state. The critical question, therefore, is why negative
examining the content of depressive cognition, recent studies mood induces some people to initiate a self-defeating cycle
have begun to investigate cognitive processes that may underlie of increasingly negative thinking and intensifying negative
and enhance the negative thoughts that characterize this disor- affect. If negative mood is, in fact, associated with activation
der (see Mathews & MacLeod, 2005, for review). Most of these of mood-congruent material in working memory, the ability
studies, however, have focused narrowly on demonstrating the to control the contents of working memory might play an
existence of cognitive deficits and biased processing in depres- important role in recovery from negative affect.
sion. Very few studies have examined how cognitive biases are A closer investigation of individual differences in cognitive
related to each other and, more importantly, how they are inhibition may help us to better understand sustained negative
related to the hallmark feature of depression: sustained nega- affect in depression (Fig. 1). Specifically, it is hypothesized
tive affect. that depressed people and people who are vulnerable to
Depressed and nondepressed individuals may not differ
much in their initial response to a negative event and depressed
individuals may even respond less strongly (Rottenberg, 2007),
Corresponding Author:
but instead differ in the degree to which they are able to repair Jutta Joormann, Department of Psychology, University of Miami, 454 Flipse
their mood once they experience sadness or other negative Building, Coral Gables, FL 33124
emotions. Negative mood is generally associated with or partly E-mail:
162 Joormann


Negative Activation of
Mood Negative

Deficits in

Access of Inability to Expel

Negative Material Negative Material
To WM From WM

Accessibility of
Rumination Reappraisal Mood-Incongruent

Enhanced Long-Term
Memory for Negative

Fig. 1. The relation among deficits in cognitive inhibition and emotion

regulation in depression. The experience of negative events leads to
negative mood, which goes along with the activation of negative cognitions.
Such changes in cognition are usually transient, and mood-congruent
cognitions are often replaced quite quickly by thoughts and memories that
serve to regulate and repair the mood state. Depression, however, is
associated with deficits in cognitive inhibition which lead to enhanced
access of negative material to working memory (WM) and difficulties
expelling negative material from WM. These deficits lead in turn to
increased rumination and to difficulties in using reappraisal and in accessing
mood-incongruent material to repair the negative affect. The prolonged
processing of negative material in WM further affects long-term memory
for negative material.

depression have difficulty disengaging from, and inhibiting inhibition deficits hinder the use of more adaptive strategies
elaborative processing of, negative stimuli. This inhibitory such as reappraisal or recall of mood-incongruent material.
deficit affects their ability to regulate negative affect in several Third, inhibition deficits also result in better long-term memory
ways. First, an inability to expel negative material from work- for negative material, which, in turn, serves to further exacer-
ing memory is related to rumination, which characterizes bate negative affect.
depressed individuals when they experience negative mood.
Rumination consists of unintended persistent and recurring
thoughts (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Cognitive Inhibition
These thoughts focus attention on the negative affect and its Overriding prepotent responses and inhibiting the processing of
implications. Rumination perpetuates depressive symptoms irrelevant material that captures attention are abilities that
and increases risk for the onset of depressive episodes. Second, allow us to respond flexibly and to adjust our behavior and
Cognitive Inhibition and Emotion Regulation in Depression 163

emotional responses to changing situations. Cognitive inhibi- clinically depressed participants, and participants with a history
tion is part of executive control processes that select and update of depressive episodes exhibited reduced inhibition of negative
the content of working memory (Hasher, Zacks, & May, 1999). words (Joormann & Gotlib, in press). No effects for positive
Working memory (WM) is a limited-capacity system that words were found. Importantly, these findings were replicated
reflects the focus of attention and the temporary activation of using a NAP task with emotional faces (Goeleven, DeRaedt,
representations that are the content of awareness. Given this Baert, & Koster, 2006).
capacity limitation, Hasher et al. (1999) proposed that the effi- Results from NAP studies suggest that depression involves
cient functioning of working memory depends on inhibitory difficulties ignoring and disengaging from negative material
processes that both limit the access of information into working that is clearly marked as irrelevant to the task. These results
memory and update the contents of working memory by reflect findings from the attention bias literature that propose
removing information that is no longer relevant. that depressed participants have difficulties disengaging their
Most contemporary theories postulate that inhibition is not a attention from negative material in their environment (see
unitary function but instead involves several components (e.g., Mathews & MacLeod, 2005, for a review). It is also important
Friedman & Miyake, 2004). In addition, cognitive inhibition to investigate, however, whether depression is associated with
operates at different stages of the processing of information difficulties removing previously relevant negative material
(Hasher et al., 1999); examples are preventing off-goal infor- from WM. Difficulties inhibiting the processing of negative
mation from having access to working memory and reducing material that was, but is no longer, relevant might explain why
the activation of information that was once relevant but now people respond to negative mood states and negative life
is irrelevant because of a change in goals. events with recurring, uncontrollable, and unintentional neg-
What happens when these processes malfunction? Too ative thoughts.
much irrelevant information gets into working memory To test this hypothesis, Joormann and Gotlib (2008) used a
(Hasher et al., 1999). As a consequence, links between relevant modified Sternberg task that combines a short-term recognition
and irrelevant information are created and stored in long-term task with instructions to expel a previously memorized list of
memory, setting the stage for slower and less accurate retrieval words from working memory. The difference in reaction times
of relevant information and enhanced retrieval of irrelevant to an intrusion probe (i.e., a probe from the irrelevant list) and
information. In addition, irrelevant information in working reaction times to a new probe (i.e., a completely new word)
memory is sustained longer. Thus, individuals who exhibit an reflects the strength of the residual activation of the contents
inhibitory deficit are easily distracted by irrelevant information of WM that were declared to be no longer relevant. Compared
and thoughts which may disrupt a coherent stream of thought. to never-depressed controls, depressed individuals exhibited lon-
ger decision latencies to an intrusion probe (i.e., a probe from the
irrelevant list) than to a new probe (i.e., a completely new word).
Cognitive Inhibition in Depression Importantly, this pattern was not found for positive words. In
Although it seems straightforward to define cognitive inhibi- sum, these findings indicate that depression is associated with
tion, it is nevertheless difficult to generate unequivocal evi- difficulties removing irrelevant negative material from WM.
dence for its role in a given task. Over the last 15 to 20
years, however, there have emerged a number of experimental
methodologies that have the potential to test inhibition models,
Cognitive Inhibition and Long-Term Memory
because they provide data that cannot be easily explained with- It is likely that deficits in cognitive control not only affect
out a concept such as cognitive inhibition. peoples ability to disengage attention from irrelevant material,
Negative priming is a task during which participants are thereby increasing unwanted thoughts, but also make it diffi-
instructed to respond to a target stimulus in the presence of a cult for them to intentionally forget unwanted material. Inves-
task-irrelevant distractor. The negative priming effect is tigators have consistently documented such memory biases in
defined as a delayed response latency when this distractor depression. Deficits in inhibition have been tested in directed
becomes the target on a subsequent trial. This delay is proposed forgetting tasks in which participants are instructed to forget
to reflect the strength of inhibition of the distractor. Whereas previously studied material at some point during the experi-
some studies using nonemotional material have reported ment. However, later recall for both material that was to be
reduced inhibition in depressed participants, inhibitory deficits remembered and material that was to be forgotten is tested.
may be expected to be particularly prevalent in the processing In a study using neutral material, Cottencin et al. (2008)
of emotional information. Thus, as illustrated in Figure 1, it is reported better recall of to-be-forgotten words and poorer recall
proposed that it is the interaction among the activation of of to-be-remembered words in depression. Using emotional
mood-congruent cognitions and inhibition deficits that leads material, Power, Dalgleish, Claudio, Tata, and Kentish
to facilitated access and an inability to expel negative material (2000) reported that depressed participants showed less forget-
from WM. ting of negative material.
The negative affective priming (NAP) task was designed to Hertel and Gerstle (2003) reported additional evidence for
assess inhibition in processing of emotional information reduced inhibition of negative words among dysphoric stu-
(Joormann, 2004). In a series of studies, dysphoric participants, dents. Participants learned word pairs and, in subsequent
164 Joormann

practice trials, either recalled the target word or suppressed the ratings improved under distraction, as well as under mood-
target word in response to a cue. Finally, recall for all words incongruent recall instructions. In contrast, dysphoric
was tested. Dysphoric participants recalled more words they participants did not benefit from recalling positive memories,
had practiced suppressing, with negative words tending to but distraction seemed to alleviate their sad mood. We recently
show the effect most strongly. Using a similar task with clini- replicated these findings among currently and previously
cally depressed participants, Joormann, Hertel, LeMoult, and depressed participants (Joormann, Siemer, & Gotlib, 2007).
Gotlib (2009) replicated these difficulties in the intentional for- Moreover, the ability to repair negative mood through recall
getting of negative material. A subset of participants, however, of positive memories was correlated with inhibition in the neg-
was trained to adopt a strategy of how to improve suppression ative priming task. These results suggest that inasmuch as
by thinking of other words that they had previously been depressed individuals are unable to inhibit mood-congruent
trained to associate with the cue (thought substitutes). In this thoughts, mood-incongruent memories remain less accessi-
condition, after some training in using this strategy, depressed blethus stabilizing, rather than repairing, negative mood.
participants were able to inhibit and forget negative words. These findings further suggest that the use of mood-
This finding is consistent with other work showing that incongruent material to repair negative affect requires active
depressed individuals can compensate for cognitive biases inhibition of mood-congruent material whereas distraction may
when given explicit strategies (Hertel, 2004), and it has intri- be characterized by a less effortful substitution of mood-
guing implications for interventions. congruent thoughts with neutral material. Distraction, there-
fore, seems to be an effective mood-regulation strategy that
works well in depression. Depressed people, however, may
Cognitive Inhibition and Emotion Regulation be less likely to use this strategy spontaneously, possibly
Deficits in controlling the contents of working memory may because they find distraction difficult to initiate.
affect emotion regulation in various ways. An inability to
appropriately expel mood-congruent items from working
memory as they become irrelevant may result in rumination.
Conclusions and Future Directions
Deficits in cognitive control may also lead to difficulties These studies are beginning to elucidate the nature of the rela-
attending to and processing new information, thereby hindering tions among emotion regulation, inhibition, and depression.
the use of more adaptive strategies. Effective reappraisal, for Because the experience of negative mood yields activation of
example, depends on a persons ability to override (automatic) mood-congruent cognitions in WM, the ability to control the
interpretation biases that lead to unwanted appraisals of the contents of WM could be crucial in differentiating people who
emotion-eliciting cues. Replacing automatic appraisals with recover easily from negative affect from those who initiate a
alternative evaluations of the situation requires cognitive con- vicious cycle of increasingly negative thinking and deepening
trol. Finally, deficits in cognitive control can make it difficult sad mood. Depressed people and people at risk for depression
to access mood-incongruent material. People frequently recruit have trouble preventing negative material from entering and
pleasant memories to repair sad mood. Difficulties inhibiting remaining in WM, leading them to rehearse, or to ruminate
salient but irrelevant thoughts could therefore reduce the use about, negative content. This not only leads to increased activa-
of more effective emotion-regulation strategies and/or render tion of mood-congruent material but also to less accessibility of
these strategies less effective. mood-incongruent material.
Few studies so far have investigated the association among Future research should focus on examining more closely the
inhibition and the use and effectiveness of emotion-regulation exact nature of inhibition deficits in depression and their rela-
strategies such as reappraisal and distraction. Numerous tion to other executive-control processes (see, e.g., Friedman &
findings, however, support the proposition that inhibition Miyake, 2004). In addition, the presented studies suggest that
deficits are related to increased rumination (e.g., Davis & inhibition deficits are specific to negative material, but more
Nolen-Hoeksema, 2000). Joormann (2006) reported a correla- studies that directly compare inhibition in the processing of
tion between rumination and deficits in cognitive inhibition neutral and emotional material in depression are needed. Future
as assessed by negative priming, and Joormann and Gotlib studies should also examine more explicitly causal relations
(2008) found a correlation between rumination and the ability among the observed variables. This paper reviewed correla-
to remove irrelevant negative material from working memory. tional studies that report relations among inhibition deficits and
Finally, Joormann and Gotlib (in press) reported that an depression and among inhibition deficits and the use of
inability to inhibit the processing of negative material was emotion-regulation strategies such as rumination and reapprai-
related to an increased likelihood of rumination and a sal. Other research has reported that depression is associated
decreased likelihood of using reappraisal, in both healthy and with more frequent use of maladaptive emotion-regulation
depressed participants. strategies and less frequent use of more adaptive strategies.
We have also examined the idea that depression is a critical These findings, however, provide only incomplete and indirect
factor in inducing mood-congruent memory retrieval, as support for the proposed model that inhibition deficits affect
opposed to mood-repair processes (Joormann & Siemer, emotion regulation, which in turn increases risk for depression.
2004). In this research, nondysphoric participants mood It will also be important to examine more closely whether
Cognitive Inhibition and Emotion Regulation in Depression 165

inhibition deficits are primarily related to the maintenance of Gross, J.J., & Thompson, R.A. (2007). Emotion regulation:
depressive episodes or also increase risk for first onset and Conceptual foundations. In J.J. Gross (Ed.), Handbook of emotion
recurrence of episodes. In this context, it would be interesting regulation (pp. 324). New York: Guilford Press. Provides defini-
to manipulate inhibitory control to examine whether this affects tions of the main concepts related to emotion and emotion regula-
the use of emotion-regulation strategies, or to conduct longitu- tion and presents a process model of emotion regulation.
dinal studies that assess inhibitory functioning and emotion Hertel, P.T. (2004). (See References). Provides a comprehensive over-
regulation prior to the onset of a depressive episode. It should view of memory in depression and discusses the role of cognitive
further be kept in mind that the presented model revolves control deficits in memory biases in this disorder.
around one prominent feature of depression: sustained negative Jonides, J., Lewis, R., Nee, D., Lustig, C., Berman, M., & Moore, K.
affect. It will be important to further explore whether inhibition (2008). The mind and brain of short-term memory. Annual Review
deficits may be related to other aspects of depression, such as of Psychology, 59, 193224. Recent review of models of short-term
lack of motivation and lack of positive affect. memory integrating behavioral and brain imaging work.
Clearly, studies that examine more systematically the Joormann, J. (2008). Cognitive aspects of depression. In I.H. Gotlib &
mechanisms that underlie inhibition deficits and their role in C. Hammen (Eds.), Handbook of depression (pp. 298321). New
the regulation of emotion are needed. Investigations integrating York: Guilford Press. Provides a comprehensive overview of cogni-
biological and psychological aspects of depression will be par- tive deficits and biases in depression.
ticularly important. A growing literature is beginning to eluci-
date the neural circuitry of emotion generation and regulation Declaration of Conflicting Interests
(e.g., Ochsner & Gross, 2005). These studies show the involve- The author declared that she had no conflicts of interest with respect to
ment of the limbic system, including the amygdala, hippocam- the authorship or the publication of this article.
pus, and parts of the anterior cingulate cortex (ACC) in the
experience of emotional states, as well as parts of the prefrontal
cortex such as the dorsolateral prefrontal cortex (DLPFC) in the
The author thanks Charles Carver and Matthias Siemer for helpful
cognitive regulation of emotion.
feedback on this manuscript.
Interestingly, Johnstone, van Reekum, Urry, Kalin, and
Davidson (2007) reported that during reappraisal of emotional
pictures, nondepressed individuals, but not their depressed References
counterparts, displayed both increased DLPFC activation Cottencin, O., Gruat, G., Thomas, P., Devos, P., Goudemand, M., &
and decreased amygdala activation, mediated by activity in Consoli, S. (2008). Directed forgetting in depression. Journal of
the ventromedial prefrontal cortex. This pattern suggests the International Neuropsychological Society, 14, 895899.
depression-related difficulties in recruiting brain regions Davis, R.N., & Nolen-Hoeksema, S. (2000). Cognitive inflexibility
involved in the cognitive control of emotions. More studies are among ruminators and nonruminators. Cognitive Therapy and
needed to increase our understanding of brain regions and Research, 24, 699711.
neural circuits involved in cognitive inhibition and emotion Friedman, N.P., & Miyake, A. (2004). The relations among inhibition
regulation in depression. and interference control functions: A latent-variable analysis.
Finally, it will be important to examine treatment Journal of Experimental Psychology: General, 133, 101135.
implications. Recently, studies have started to investigate the Goeleven, E., DeRaedt, R., Baert, S., & Koster, E.H.W. (2006). Defi-
possibility of training cognitive control among depressed per- cient inhibition of emotional information in depression. Journal of
sons and examining the effects of this training on emotion Affective Disorders, 93, 149152.
regulation. Siegle, Thompson, Carter, Steinhauer, and Thase Hasher, L., Zacks, R.T., & May, C.P. (1999). Inhibitory control, circa-
(2007), for example, found that a brief intervention targeted dian arousal, and age. In D. Gopher & A. Koriat (Eds.), Attention
at increasing cognitive control in severely depressed outpati- and performance XVII: Cognitive regulation of performance:
ents led to significant decreases in both depressive symptoms Interaction of theory and application (pp. 653675). Cambridge,
and rumination. This suggests that cognitive control can be MA: MIT Press.
improved with practice and further supports the hypothesis Hertel, P.T. (2004). Memory for emotional and nonemotional events
that individual differences in cognitive control may affect in depression: A question of habit? In D. Reisberg & P.
emotion regulation. Hertel (Eds.), Memory and emotion (pp. 186216). New York:
Oxford University Press.
Hertel, P.T., & Gerstle, M. (2003). Depressive deficits in forgetting.
Psychological Science, 14, 573578.
Recommended Reading Johnstone, T., van Reekum, C., Urry, H., Kalin, N., & Davidson, R.
Carver, C.S., Johnson, S.L., & Joormann, J. (2008). Serotonergic (2007). Failure to regulate: Counterproductive recruitment of
function, two-mode models of self-regulation, and vulnerability to top-down prefrontal-subcortical circuitry in major depression.
depression: What depression has in common with impulsive aggres- Journal of Neuroscience, 27, 88778884.
sion. Psychological Bulletin, 134, 912943. Discusses the role of Joormann, J. (2004). Attentional bias in dysphoria: The role of inhibi-
serotonin in cognitive control and its relation to depression. tory processes. Cognition and Emotion, 18, 125147.
166 Joormann

Joormann, J. (2006). The relation of rumination and inhibition: Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emo-
Evidence from a negative priming task. Cognitive Therapy and tional disorders. Annual Review of Clinical Psychology, 1, 167195.
Research, 30, 149160. Nolen-Hoeksema, S., Wisco, B.E., & Lyubomirsky, S. (2008). Rethink-
Joormann, J., & Gotlib, I.H. (2008). Updating the contents of working ing rumination. Perspectives on Psychological Science, 3, 400424.
memory in depression: Interference from irrelevant negative mate- Ochsner, K., & Gross, J. (2005). The cognitive control of emotion.
rial. Journal of Abnormal Psychology, 117, 182192. Trends in Cognitive Sciences, 9, 242249.
Joormann, J., & Gotlib, I.H. (in press). Emotion regulation in Power, M.J., Dalgleish, T., Claudio, V., Tata, P., & Kentish, J. (2000).
depression: Relation to cognitive inhibition. Cognition and The directed forgetting task: Application to emotionally valent
Emotion. material. Journal of Affective Disorders, 57, 147157.
Joormann, J., Hertel, P., LeMoult, J., & Gotlib, I.H. (2009). Training Rottenberg, J. (2007). Major depressive disorder: Emerging evidence
intentional forgetting of negative material in depression. Journal of for emotion context insensitivity. In J. Rottenberg & S.L.
Abnormal Psychology, 118, 3443. Johnson (Eds.), Emotion and psychopathology: Bridging affective
Joormann, J., & Siemer, M. (2004). Memory accessibility, mood and clinical science (pp. 151165). Washington, DC: American
regulation, and dysphoria: Difficulties in repairing sad mood Psychological Association.
with happy memories? Journal of Abnormal Psychology, 113, Siegle, G., Thompson, W., Carter, C., Steinhauer, S., & Thase, M.
179188. (2007). Increased amygdala and decreased dorsolateral prefrontal
Joormann, J., Siemer, M., & Gotlib, I.H. (2007). Mood regulation in BOLD responses in unipolar depression: Related and independent
depression: Differential effects of distraction and recall of happy features. Biological Psychiatry, 61, 198209.
memories on sad mood. Journal of Abnormal Psychology, 116, Siemer, M. (2005). Mood-congruent cognitions constitute mood expe-
484490. rience. Emotion, 5, 296308.