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Biased attention and dysphoria: Manipulating

selective attention reduces subsequent
depressive symptoms
a a
Tony T. Wells & Christopher G. Beevers
a
University of Texas, Austin, TX, USA
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To cite this article: Tony T. Wells & Christopher G. Beevers (2010): Biased attention and dysphoria:
Manipulating selective attention reduces subsequent depressive symptoms, Cognition & Emotion, 24:4,
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 COGNITION AND EMOTION
2010, 24 (4), 719
728

BRIEF REPORT

Biased attention and dysphoria: Manipulating selective

attention reduces subsequent depressive symptoms

Tony T. Wells and Christopher G. Beevers

University of Texas, Austin, TX, USA
Downloaded by [Duke University Libraries] at 10:01 13 March 2013

Selective attention for dysphoric stimuli has been observed in individuals with depression and those
at risk for depression. To date, no studies have investigated the effects of directly manipulating
selective attention for dysphoric stimuli on depressive symptoms. Mild to moderately depressed
college students (N34) were randomly assigned to complete 4 sessions of either attention training
(AT) or no training (NT) during a two-week period. Participants completed self-reported
assessments of depressive symptoms at baseline, post-training, and follow-up. Participants in the
AT condition had a significantly greater decrease in depressive symptoms from baseline to follow-up
than participants in the NT condition. This group difference was mediated by change in attention
bias. Our findings suggest that biased attention may have a causal role in the maintenance of
depressive symptoms.

Keywords: Information processing; Biased attention; Training; Depression.

INTRODUCTION participants with generalised anxiety disorder or

Cognitive theories of depression (e.g., Beck, 1976;
Teasdale, 1988) argue that depression is main-
tained in part by an attentional bias for depres-
sion-relevant themes. In line with these theories,
several studies have documented a selective atten-
tional bias towards negative stimuli in depression.
Gotlib, Krasnoperova, Yue, and Joormann (2004)
reported that clinically depressed people selec-
tively attended to sad faces. Further, the atten-
tional bias was specific to sad faces and not angry
or happy faces. Also, this bias was not evident in
in non-psychiatric controls. This suggests a
specificity of the bias; namely, that the bias is
for dysphoric stimuli rather than for all negative
stimuli and that the bias is specific to depression
rather than to psychopathology in general (see
Mogg & Bradley, 2005, for a review).
Thus, there is a growing body of evidence that
an attentional bias for dysphoric stimuli is asso-
ciated with depression. However, a critical ques-
tion remains unanswered. Specifically, is selective
attention for dysphoric stimuli simply a by-
product of depression or might it have a causal

Correspondence should be addressed to: Tony T. Wells, Department of Psychology, University of Texas at Austin, 1 University
Station A8000, Austin, TX 78712
0187, USA. E-mail: wells@mail.utexas.edu

# 2009 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business 719
http://www.psypress.com/cogemotion DOI:10.1080/02699930802652388
 WELLS AND BEEVERS
role in the maintenance of the disorder?
Earlier research indicated that attentional biases
faded with remission of depressive symptoms
(e.g., Gotlib & Cane, 1987; McCabe & Gotlib,
1993), suggesting that selective attention for
dysphoric stimuli might be an epiphenomenon
of depression. However, more recent studies have
observed biased processing of emotional informa-
tion outside the context of a mood episode. For
example, Beevers and Carver (2003) found that
increased attentional bias following a dysphoric
mood induction, combined with life stress, pre-
dicted increases in future dysphoria in non-
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depressed college students. Joormann, Talbot,
and Gotlib (2007) found a bias for sad faces
following a sad mood induction in never de-
pressed girls at risk for developing depression.
Joormann and Gotlib (2007) found this same bias
for sad faces in individuals who had remitted from
major depression.
These studies suggest that selective attention is
unlikely to simply be a by-product or symptom of
the disorder; however, these studies are correla-
tional and cannot rule out third-variable explana-
tions. A more direct method for testing the causal
relationship between selective attention and main-
tenance of depression would be to examine the
effects of modifying attention on depressive
symptoms. Papageorgiou and Wells (2000) used
a case series design to test an attention-training
procedure with clinically depressed individuals.
Using a therapist-guided procedure to train
attentional control, they found that attention
training improved participants’ depressive symp-
toms. However, the authors noted a number of
limitations which included small sample size, lack
of objective methods of assessment, and lack of a
control group. While this provides preliminary
evidence, no randomised, controlled study has
examined whether modifying biased attention
reduces depression symptoms.
MacLeod, Rutherford, Campbell, Ebsworthy,
and Holker (2002) were able to affect non-clinical
participants’ emotional vulnerability with a com-
puter-administered dot-probe task that was
designed to modify selective attention to negative
stimuli. Participants trained to preferentially
720 COGNITION AND EMOTION, 2010, 24 (4)
attend to negative words compared with neutral
words reacted with more negative emotion to a
stressful anagram task than participants who had
been trained to attend to neutral words. This was
the first demonstration that selective attention
could play a causal role in emotional vulnerability.
Importantly, this study also demonstrated that
selective attention can be modified through atten-
tion training.
In the current investigation we tested the
hypothesis that biased attention plays a maintain-
ing role in depression. More specifically, we
investigated whether modifying selective attention
for dysphoric stimuli could reduce depressive
symptoms. We used a dot-probe task to modify
selective attention for dysphoric stimuli in people
with elevated depressive symptoms. We also
created a no training condition that was highly
similar to the training condition with the excep-
tion that selective attention was assessed, but not
modified.
We predicted that attentional bias for dysphoric
stimuli would significantly decrease in the training
condition and that no change would occur in the
no-training condition. We also predicted that
participants assigned to the training condition
would experience a decrease in depressive symp-
toms but the participants in the no-training
condition would not. Finally, we hypothesised
that the association between attention training
and reductions in depressive symptoms would be
mediated by change in attentional bias.
METHOD
Participants
Participants were 34 undergraduate students with
mild to moderate symptoms of depression who
completed the study as part of a research require-
ment for an introduction to psychology course.
Participants completed the short form of the Beck
Depression Inventory (BDI; Beck & Steer, 1993)
during mass pre-testing. Participants whose scores
were above 7 on the short form of the BDI were
contacted about participating in the current study.
Of the 345 who were contacted, 50 attended the
 ATTENTION TRAINING REDUCES DEPRESSIVE SYMPTOMS
baseline laboratory session. Among those who
were scheduled to participate, 16 were no longer
experiencing mild-to-moderate symptoms of
depression (i.e., a BDI-II score between 9 and
25) and were dismissed from the study. In order
to select a sample with at least mild symptoms of
depression, we used a BDI-II cut-off score of 9,
which has been shown to maximise sensitivity in
selecting for depressed mood in a college sample
(Sprinkle et al., 2002). Of the remaining 34 who
met study criteria, 91% completed all 4 training
sessions and the post-training session assessment
and 53% completed the follow-up session. Full
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and partial data obtained from all 34 participants
were used in analyses.
Materials
A set of 12 pairs of faces, each from a different
actor (6 males and 6 females) and each expressing
sad and neutral emotions, was selected from the
Pictures of Facial Affect (POFA) photo set
developed by Ekman and Friesen (1976). We
also selected 20 images from the International
Affective Picture System (IAPS; Lang, Bradley,
& Cuthbert, 2005), 10 displaying a neutral scene
or image and 10 displaying a dysphoric scene or
image.1 An example of a dysphoric IAPS scene
includes several children with torn and tattered
clothes facing the viewer. The children are
crowded together and appear to be in great
distress with several children clearly crying. An
example of a neutral scene includes a middle-aged
man sitting outside reading a newspaper. Faces
and images were used rather than word stimuli
due to the success of other recent studies in
detecting a bias using these types of stimuli (e.g.,
Eizenman et al., 2003; Joormann & Gotlib,
2007). The images were presented on a 20-inch
LCD PC monitor.
Procedure
Upon meeting the inclusion criteria, participants
were scheduled to return for 4 training sessions
1
We used the following IAPS images. Neutral: 2102, 2393, 2745, 2850, 5390, 5731, 7009, 7041, 7053, and 7493. Dysphoric:
2141, 2205, 2276, 2455, 2700, 2703, 2799, 2900, 9421, and 9530.
(described below) during the 2 weeks following
the baseline laboratory session. They were also
scheduled for a post-training assessment session 2
weeks from the baseline screening appointment
and a follow-up assessment session that occurred
4 weeks after the baseline session. Participants
were awarded experimental credit for their intro-
ductory psychology course for participation at
baseline, training sessions, and post-training.
This provided their full allotment of credit, so
participants were offered $5 and entry in a raffle
to win $75 for participation in the follow-up. At
the baseline, post-training, and follow-up sessions
(each separated by two weeks), participants com-
pleted the BDI-II. Participants also completed
the Beck Anxiety Inventory (BAI; Beck, Epstein,
Brown, & Steer, 1988) at baseline.
Participants were told that the purpose of the
study was to examine the relationship between
mood and attention. It is important to note that
the term ‘‘training’’ was not mentioned to the
participants. They were told that they would be
returning over several sessions to help validate an
attention task. They were not given any informa-
tion that they might be undergoing attention
training or that it could improve their mood until
they were debriefed at the end of the experiment.
This ensured that the participants were unaware
of the study purpose as well as experimental
condition. In addition, participants were assigned
randomly to the attention training or no training
conditions. The experimenters were blind to the
conditions of participants until completion of
the experiment. Before debriefing at the end of
the study, participants were asked to guess the
purpose of the task. No participants correctly
guessed the purpose or hypothesis of the study.
Design
Dot-probe task. The set of 22 image pairs (12
POFA face pairs and 10 IAPS image pairs) was
presented in 9 blocks in each session for a total of
196 trials per session. Each POFA pair consisted of
COGNITION AND EMOTION, 2010, 24 (4) 721
 WELLS AND BEEVERS
one sad face and one neutral face of the same actor.
One IAPS neutral image was always paired with
one IAPS dysphoric image in the IAPS pairs;
however, the pairings were randomly chosen dur-
ing each new block. Total time to complete each
training session was approximately 25 minutes.
Each trial consisted of a white fixation cross on
a black background in the centre of the screen for
1500 ms, followed by an image pair. The size of
each POFA image was approximately 12.7 session, participants were randomly assigned by
19 cm (subtending approximately 128188 of
the visual angle) and each IAPS image was
approximately 17.112.7 cm (approximately
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168128). The pictures in each pair were
approximately 21 cm apart when measured from
each centre and were presented in the left and
right halves of the screen. This gave a visual angle
of approximately 208 between the centres of each
image and 108 between the image centre and the
fixation cross.
POFA pairs were presented for 3000 ms and
IAPS pairs were presented for 4500 ms. The
relatively longer stimulus durations compared to
standard dot-probe administrations (e.g., Gotlib
et al., 2004) were intended to allow participants
time to more fully process the content of the
stimuli, as longer durations may allow for more
elaborated processing and greater activation of
relevant schemata (Mogg & Bradley, 2005).
Following the offset of the images, a small single
or double white asterisk probe on a black back-
ground appeared in the location of one of the
images and remained on the screen until the
participant pressed a corresponding response-box
button to indicate whether they saw one or two
asterisks. The computer recorded the latency and
accuracy of each response. Each type of emotional
stimulus (sad or neutral) and probe stimulus
(single or double asterisk) appeared on each side
of the screen with equal probability.
Task presentation. Participants were told that
their goal was to determine whether they saw
one or two asterisks as quickly and accurately as
possible. They used their index finger to press a
button marked * when they saw one asterisk and
used their middle finger to press ** when they saw
722 COGNITION AND EMOTION, 2010, 24 (4)
two asterisks. Participants completed 11 practice
trials (5 IAPS and 6 POFA pairs) using neutral

neutral pairs. These practice trials used an equal
probability distribution for the probe for all
participants. Participants repeated the practice
until they responded accurately to at least 9 of
the 11 practice trials.
Training manipulation. At the first training
computer to attention training (AT) or no train-
ing (NT) conditions. The conditions differed only
in the probability of the probe location following
the neutral
dysphoric stimulus pair. In the NT
condition, the probe appeared in the location of
the neutral stimulus and the dysphoric stimulus
with equal probability (50%). In the AT condi-
tion, however, the probe appeared in the location
of the neutral stimulus 85% of the time. We used
85% rather than 100% for two reasons: to allow
for assessment of attention bias during the task
and to keep the intent of the study from being
transparent. Sixty standard dot-probe trials (i.e.,
equal probability of the probe appearing in the
location of each stimulus) in the first and last
training sessions were used to calculate attention
bias in both the AT and NT conditions.
This 85% probe distribution in the AT condi-
tion served as the critical manipulation whereby
the participants were putatively trained to allocate
their attention preferentially to the neutral
stimuli. This was intended to train participants
to allocate their attention away from the dysphoric
stimuli.
RESULTS
Mean age for the sample was 19.1 (SD1.7).
There were no significant differences between
training conditions in the proportion of women
(Ns: AT13, NT11), x2(1, N24)B1, ns,
number of dropouts, x2(1, N16)B1, ns, age,
t(32)B1, ns, BAI score, t(32)B1, ns, or initial
BDI-II score, t(32)1.12, p.27. Mean BDI-II
scores (and standard deviations) for the sample as
a whole, the AT condition, and the NT condition
 ATTENTION TRAINING REDUCES DEPRESSIVE SYMPTOMS
were 16.1 (4.8), 17.1 (5.5), and 15.2 (4.1),
respectively. Mean BAI scores were 11.6 (6.7),
11.9 (7.5), and 11.3 (6.1), respectively. Two
participants in the NT condition were taking
antidepressant medication during the study; and
no participants in the AT condition reported
taking antidepressant medication. Analyses with-
out or with these two participants from the NT
condition resulted in an identical pattern of
results. Therefore, they were included in all
analyses reported below.
Of the 34 participants who were randomised to
a training condition, 31 (Ns: AT14, NT17)
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completed the post-training session and 18 (Ns:
AT7, NT11) completed the follow-up.
There were no significant differences between
participants who completed the post-training
session and those who did not on baseline BDI-
II scores, BAI scores, or age, all ts(32)B1, ns.
Similarly, participants who dropped out before
the follow-up session did not differ significantly
on baseline BDI-II score, BAI scores, or age from
those who completed the follow-up session, all
ts(32)B1, ns. Data obtained from all participants
who started the study protocol were used in
analyses; data for missed sessions were estimated.
Missing data
Full Information Maximum Likelihood (FIML)
estimation was used to estimate missing data (see
Little & Rubin, 2002, for more detail on FIML-
estimation procedures). The patterns of missing
data in the current study were consistent with the
assumption that the data are missing at random,
as determined by Little’s (1988) MCAR test,
x2(202)197.45, p.58. FIML was thus an
appropriate estimator for our missing data.
Dot-probe task
Data reduction. We analysed response latencies
only from correct responses. Eliminating incorrect
responses resulted in a loss of less than 1% of data
and error rates did not differ between the two
conditions, t(31)1.21, p.24. Response laten-
cies three standard deviations faster or slower than
the mean response latency calculated separately
for each participant, were considered outliers and
were eliminated. This resulted in a loss of 1.64%
of the data and did not differ between conditions,
t(31)1.35, p.19.
Bias scores. In line with the procedure of Gotlib
et al. (2004), attentional bias scores were calcu-
lated for each participant for each of the four
training sessions using the following equation:
Attentional bias score
1
 [(RpLeRpRe)(LpLeLpLe)] 1
2
where Rright position, Lleft position, p
probe, and eemotional (dysphoric) stimulus.
Therefore, RpLe indicates the mean response
latency when the probe is in the right position
and the dysphoric stimulus is in the left position,
and so on.
Effect of attention training on attentional
bias score
There was no significant main effect for time on
attention bias, F(1, 32)1.28, p.27, but there
was a main effect for training condition, F(1,
32)14.16, p.001, h2 .31. More impor-
tantly, a 2 (Time: training session 1, 4)2
(Training Condition: AT, NT) repeated-mea-
sures analysis of variance (ANOVA) revealed a
significant interaction between Time and Train-
ing Condition, F(1, 32)6.14, p.02, h2 .16,
for predicting change in attention bias. Follow-up
dependent measures t-tests indicated that the AT
group demonstrated a significant decrease in bias
score for dysphoric stimuli, t(15)2.16, p.047,
whereas bias score did not significantly change for
the NT group, t(17)1.16, p.26 (see Figure
1). In addition, the NT and AT groups were
significantly different from each other at session 4
(NT mean14.7 ms; AT mean 30.5 ms),
t(32)4.58, pB.001. Thus, the attention train-
ing manipulation had its intended effect: it
significantly reduced attention for sad stimuli
and increased attention toward neutral stimuli in
the AT group but not the NT group.
COGNITION AND EMOTION, 2010, 24 (4) 723
 WELLS AND BEEVERS
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Figure 1. Bias score for dysphoric stimuli at sessions 1 and 4 completed within a two-week time period for the attention training (AT) and
no training (NT) conditions. Error bars represent the standard error of the mean.
Effect of attention training on change in
depressive symptoms
A 3 (Time: baseline, post-training, follow-up)2
(Training: AT, NT) repeated-measures ANOVA
revealed a significant interaction between Time
and Training Condition, F(2, 31)7.31, p
.003, h2 .32, for predicting change in depressive
symptoms. Compared to baseline, the AT group
reported a significant decrease in depressive
symptoms at post-training, t(15)3.15, p
.007, Cohen’s d0.52, and follow-up, t(15)
4.82, pB.001, d1.04, while no change was
observed in NT for post-training or follow-up,
both ts(17)B1, ns (see Figure 2). There were no
significant differences between NT and AT in
depressive symptoms at post-training, t(32)B1,
ns, but the groups did differ significantly at
follow-up, t(32)2.09, p.045, d0.71.
To determine whether our method for esti-
mating missing data substantially influenced our
results, we ran these analyses (a) without estimat-
ing any missing data and (b) using the last
observation carried forward technique. Without
estimating missing data, a 3 (Time)2 (Training
Condition) repeated-measures ANOVA revealed
a significant interaction between Time and Train-
ing Condition for BDI, F(2, 15)7.66, p.005,
h2 .51. Using the last observation carried for-
ward, a 3 (Time)2 (Training Condition)
724 COGNITION AND EMOTION, 2010, 24 (4)
repeated-measures ANOVA also revealed a sig-
nificant interaction between Time and Training
Condition for BDI, F(2, 31)4.9, p.014,
h2 .24. These results were highly consistent
with our main analyses.
Mediation analyses
We used path analysis to test whether change in
attentional bias mediated the relationship between
attention-training condition and depression
symptoms at follow-up. Several indices are often
used to determine quality of model fit. Among the
most commonly used are: x2, Comparative Fit
Index (CFI), and Standardised Root Mean
Square Residual (SRMR). Model fit that includes
a x2/dfB2, CFI ].90, SRMR 5.10 is generally
acceptable (see Kline, 1998). These criteria were
used in the present study.
We developed a path model that examined
whether bias score at session 4 (the last attention
training session) mediated the association
between attention-training condition and depres-
sive symptoms at follow-up. Our mediation
model is depicted in Figure 3. Specifically, we
posited a direct effect from attention-training
condition to bias score at session 4, and a direct
effect from bias score at session 4 to follow-up
BDI-II. We also posited direct effects from bias

19
17
BDI
15
13
11
9
Baseline
Figure 2. Self-reported depression (BDI-II) measured at baseline, post-training, and follow-up for the attention training (AT) and no
training (NT) conditions. Error bars represent the standard error of the mean. Figure includes estimated data.
Downloaded by [Duke University Libraries] at 10:01 13 March 2013
score at session 1 and baseline BDI-II to their
respective subsequent assessments.
This initial model achieved an adequate fit,
x2(3)5.57, p.13, x2/df1.85, CFI.92,
SRMR.10. More importantly, assignment to
the AT condition (training away from dysphoric
images) was strongly associated with reductions in
biased attention for dysphoric stimuli at session 4,
controlling for bias at session 1. Further, a lower
bias score at session 4 was associated with fewer
depression symptoms at follow-up, controlling for
baseline depressive symptoms. This model ex-
plained 53.1% of the variance in depression at
follow-up.
To evaluate the specificity of our model, we
tested an alternative mediational model. Specifi-
cally, we examined whether bias score at session 1
mediated the relationship between attention
training and BDI-II at follow-up. We thus tested
the same model as in Figure 3, but we removed
Attention Training −.65*
Condition
Figure 3. Results from path analyses indicating that attentional bias at session 4 (controlling for attention bias at session 1) mediates the
association between attention training condition (coded 0 NT, 1AT) and depressive symptoms at follow-up (controlling for baseline
depressive symptoms).
ATTENTION TRAINING REDUCES DEPRESSIVE SYMPTOMS
NT AT
Post-training Follow-up
Time
bias score at session 4 and replaced it with bias
score at session 1. This model did not achieve
good fit, x2(2)10.84, pB.01, x2/df5.42,
CFI.28, SRMR.19. Taken together, our
results suggest that change in attentional bias
mediates the association between attention train-
ing and depressive symptoms at follow-up.
DISCUSSION
This study examined whether an attention-training
task designed to reduce a bias for dysphoric stimuli,
compared to a similar task that had no training
component, would lead to mood improvement in
participants with mild-to-moderate levels of de-
pressive symptoms. Consistent with our predic-
tions, attention training (AT) led to a reduction in
depressive symptoms while participants in the no
training condition (NT) experienced no significant
Bias Score – Baseline BDI-II
Session 1
−.09 .57*
Bias Score – .52* Follow-up
Session 4 BDI-II
COGNITION AND EMOTION, 2010, 24 (4) 725
 WELLS AND BEEVERS
change. Effect sizes for attention training were in
the medium-to-large range using definitions pro-
posed by Cohen (1988). The interaction between
time and training group explained approximately
one third of the variance in BDI-II score. The
effect size for change in depressive symptoms in the
AT group was medium for baseline to post-
training and large for baseline to follow-up. In
contrast, the effect size for change in depressive
symptoms in the no-training condition was close to
zero. Finally, attention training also reduced biased
attention for dysphoric stimuli, which in turn
mediated the association between attention train-
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ing and reductions in depressive symptoms.
To our knowledge, this is the first study to
examine the effects of attention training on
depressive symptoms using a no-training control
condition and carefully controlling for expectancy
effects. The current study controlled for expec-
tancy effects in that participants and experimen-
ters were unaware of whether participants were
assigned to the active or inert training conditions.
In fact, our study went a step further to reduce
expectancy effects by not revealing until the end of
the study that there were two separate training
conditions and that one condition could alter
depressive symptoms. This enabled us to effec-
tively rule out expectancy effects as a factor in the
improvement observed in the AT condition.
Importantly, we observed a decrease in atten-
tional bias for dysphoric stimuli in the AT group
but not the NT group. Participants displayed an
increased bias towards neutral stimuli and away
from dysphoric stimuli over time in the AT
condition, but relatively little change in the NT
condition. Thus, change in attentional bias
appeared to mediate the effect of training condi-
tion on change in depression symptoms.
Our study illuminates the relationship between
depression and attentional bias for dysphoric
stimuli. The current study is the first that we
are aware of to find that experimentally manip-
ulating attentional bias for dysphoric stimuli can
lead to symptom reduction. The results of this
study suggest that selective attention for dysphoric
stimuli plays an important role in the maintenance
of depressive symptoms. These findings also
726 COGNITION AND EMOTION, 2010, 24 (4)
bolster the argument that, rather than being a
by-product of depression, selective attention has a
causal role in the maintenance of the disorder.
The results of this study should be interpreted
with some limitations in mind. Perhaps the most
significant limitation is the dropout rate before
the follow-up session; 53% of participants com-
pleted the follow-up session. However, we took
several steps to ensure reliability of the reported
effects. Namely, our method of estimating miss-
ing data (FIML) is considered a ‘‘state-of-the-art’’
approach (Schafer & Graham, 2002). FIML has
been shown to be superior to removing cases with
missing data (i.e., listwise deletion) for a several
statistical techniques (Enders, 2001; Enders &
Bandalos, 2001). In addition, Little and Rubin
(2002) and Schafer (1997) have both suggested
that FIML data estimation methods can be used
reliably when up to 90% of the data are missing
for a particular variable; however, in such circum-
stances, analyses involving that variable rely on
model and missing data assumptions to a greater
degree than when missing data are minimal. It
should also be noted that our analyses using
listwise deletion and last observation carried
forward produced very similar results to those
using FIML estimated data, indicating consis-
tency between results produced by different
methods of data estimation as well as non-
estimated data. Future studies with larger sample
sizes and better participant retention are needed
to replicate our findings.
A second limitation is that we did not have an
‘‘assessment only’’ control group. An alternative
interpretation for our results is that the AT group
improved naturally while some component of the
NT condition prevented those participants from
improving. In other words, though the NT
condition involved a standard dot-probe task, it
may not have been completely inert. Though this
design limitation is common to studies of atten-
tion training (e.g., MacLeod et al., 2002; Li, Tan,
Qian, & Liu, 2008), future studies should imple-
ment an assessment-only control to address this.
A third limitation is that the same stimuli were
used in the attention training and the assessment
of attention bias at the first and fourth training

sessions. Though this is not an optimal procedure,
MacLeod et al. (2002) found that their attention
training produced no significantly different post-
training effects on new stimuli compared to
stimuli on which the participant had been trained.
This indicates that attention training seems to
affect both previously viewed and new stimuli
similarly. However, future studies should use
different stimuli for attention training to reliably
assess the external validity of change in bias
scores. The current study did not assess major
depression and so some participants would not
have met criteria for clinical depression. Addi-
Downloaded by [Duke University Libraries] at 10:01 13 March 2013
tionally, we restricted our sample to individuals
who had mild to moderate levels of depressive
symptoms. Future research can use a broader
community sample that has been assessed for
major depression through a clinical interview.
In summary, this study provides evidence for
the first time that attention training reduces
depressive symptoms. A mediation analysis sug-
gested that training attention away from dyspho-
ric stimuli and towards neutral stimuli accounts
for the subsequent change in depression. In
addition, these effects were achieved in the
absence of expectancy effects and lasted beyond
the duration of training. Perhaps most notably,
these results provide additional evidence that,
rather than being by-products or symptoms of
depression, attentional biases play a causal role in
the maintenance of depressive symptoms.
Manuscript received 4 August
Revised manuscript received 24 November
Manuscript accepted 26 November
First published online 4 February
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