Philips, W., Hine, D., & Thorsteinsson, E. (2010) Implicit Cognition and Depression A Meta Analysis

Clinical Psychology Review 30 (2010) 691–709
Contents lists available at ScienceDirect
Clinical Psychology Review
Implicit cognition and depression: A meta-analysis

Wendy J. Phillips ⁎, Donald W. Hine, Einar B. Thorsteinsson
School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, NSW, 2351, Australia
a r t i c l e i n f o a b s t r a c t
Article history: This study examined the relationship between negative self-referential implicit cognition and depression. A
Received 18 November 2009 meta-analysis of 89 effect sizes from a pooled sample of 7032 produced a weighted average effect size of
Received in revised form 10 May 2010 r = .23. Moderator analyses, using an expanded set of 202 effect sizes, indicated that effect sizes relating to all
Accepted 14 May 2010
facets of cognition, study designs and sample types significantly predicted depression. Significant
heterogeneity was observed in effect sizes across facets of cognition, cognitive manipulations and
Keywords:
Depression
measurement strategies. Studies that assessed interpretation and self-beliefs, utilized mood and cognitive
Cognitive bias load manipulations, and employed the Self-Descriptiveness Judgement Task produced the largest effect sizes.
Implicit The transfer-appropriate processing view of implicit memory was supported and significant biases were
Dual-process observed at both early and late stages of attention. Overall, results support cognitive models of depression
Meta-analysis and suggest that implicit cognition reliably predicts past, current, and future depression. Consequently,
Self-reference treatment efficacy may be improved by incorporating strategies that target implicit processes.
© 2010 Elsevier Ltd. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 692
1.1. Facets of cognition and measurement strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 692
1.1.1. Attention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 692
1.1.2. Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 693
1.1.3. Interpretation and self-beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 694
1.1.4. Self-esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
1.2. Study design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
1.3. Cognitive reactivity and control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696
1.4. Rationale for this meta-analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696
2. Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696
2.1. Literature search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 696
2.2. Inclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.2.1. Stimuli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.2.2. Samples and depressive status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.2.3. Implicitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.2.4. Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3. Moderator coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3.1. Aspect of cognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3.2. Cognitive reactivity and control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3.3. Sample type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3.4. Measurement strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697
2.3.5. Priming threshold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
2.3.6. Processing level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
⁎ Corresponding author. Tel.: +61 2 6773 3606; fax: +61 2 6773 3820.
E-mail address: wphillip@une.edu.au (W.J. Phillips).
0272-7358/$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.cpr.2010.05.002
692 W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709
2.4. Inter-coder reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703

2.5. Statistical analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704
4.1. Theoretical implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 704
4.2. Methodological implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705
4.3. Treatment implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 705
4.4. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 706
4.5. Future directions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 706
4.6. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
1. Introduction remains uncorrected by explicit processing. In this conceptualization,

an initial response to a negative stimulus represents the activation of
Depression is believed to occur when negative self-beliefs and negative implicit schemas. Corrective explicit processing may rein-
processing biases impede an individual's ability to regulate emotional terpret the stimulus and override the negative implicit response,
responses to adverse experiences. According to cognitive theories of which relieves negative affect. However, vulnerability may be
depression, depressed individuals possess representations of self- exposed when negatively biased implicit cognitions remain uncor-
referential information involving themes of loss, failure, worthless- rected by explicit processing; resulting in negative explicit cognitions,
ness, rejection and hopelessness (Abramson, Metalsky, & Alloy, 1989; increased dysphoria, depleted cognitive resources and a downward
Beck, 1967; Ingram, Miranda, & Segal, 1998). When activated by an spiral into depression. Thus, implicit cognitions are hypothesized to
environmental trigger, self-schemas are thought to generate auto- represent the origin of depression. Haeffel et al. (2007) proposed a
matic and systematic biases in information processing. Patterns of similar model, but expressed the converse view that explicit
activation are presumed to reflect existing cognitive structures, where cognitions are most critical because they represent the more proximal
one activated negative memory or emotion node activates all other cognitive determinants of depression.
nodes in an individual's associative network (Beck, 2008; Bower, In accordance with dual process formulations, empirical evidence
1981; Ingram et al., 1998; Teasdale, 1988). Therefore, activated suggests that depression interferes with effortful processing but
schemas increase the likelihood of depressive episodes, and the only minimally disrupts automatic processing (e.g., Bargh & Tota,
presence of a negative self-schema represents a relatively stable 1988; Hammar, Lund, & Hugdahl, 2003; Hartlage, Alloy, Vázquez, &
vulnerability factor for future depression. Dykman, 1993). For example, several studies have observed biases
Although most theoretical approaches to depression agree that amongst depression-vulnerable individuals only under conditions in
negative self-views play an important role in depression, the which their cognitive resources have been experimentally depleted
hypothesized manner in which they exert their influence is more and automatic processes exposed (e.g., Wenzlaff & Bates, 1998;
contentious. Some researchers believe that individuals are at greatest Wenzlaff & Eisenberg, 2001). Similarly, neurophysiological research
risk for depression when they consciously possess negative self- suggests that depressed individuals experience increased activity in
referential attitudes and engage in self-defeating reasoning and limbic brain regions associated with emotional responses, and
thinking styles (e.g., Alloy et al., 2000; Nolen-Hoeksema, 2000). decreased activity in frontal regions that regulate limbic activity
Other researchers consider that negative self-schemas precipitate (e.g., Johnstone, van Reekum, Urry, Kalin, & Davidson, 2007; Siegle,
depression by influencing automatic, often preconscious, cognitive Thompson, Carter, Steinhauer, & Thase, 2007). In summary,
responses to experiences (for reviews, see Ingram et al., 1998; Scher, dysregulated top-down processing appears to be coupled with
Ingram, & Segal, 2005). Considerable bodies of research have accentuated bottom-up processing, resulting in the dominance of
addressed both views. the latter.
Recently, conscious versus automatic perspectives have been The hypothesized interplay between processing systems in
integrated within a dual-processing framework. Dual process theories depression suggests that corrective explicit processes would not be
advocate that people possess two distinct information processing required, and negatively biased explicit cognitions would not occur, if
systems: 1) an implicit system that involves automatic processing, implicit self-referential cognitions were predominantly positive. Thus,
requires little cognitive effort, and is guided by slow-forming increasing our understanding of biased implicit cognitions in
associative memory constructs, and 2) an explicit system that employs depression represents an important research goal.
deliberate processing, involves motivated effort, and is directed by
rapidly-acquired rule-based learning (Evans, 2008). Regarded as
1.1. Facets of cognition and measurement strategies
output from the two systems, implicit and explicit cognitions are
presumed to possess the characteristics of their system of origin.
Cognitive models of depression predict that depressed individuals
Deemed to represent conscious evaluations, explicit cognitions are
will exhibit negative biases in implicit attitudes toward the self, and in
widely assessed by measures that require participants' deliberate
all aspects of information processing. Particularly relevant facets of
consideration (e.g., self-report questionnaires). In contrast, the
cognition include attention, memory, interpretation, self-beliefs and
automatic nature of implicit cognitions requires assessment under
self-esteem. A summary of these facets is provided in the sections that
indirect, unconscious or uncontrolled conditions (e.g., reaction times
follow, along with descriptions of the primary measures used to assess
or memory associations).
them.
According to Forgas (2000), healthy mood regulation involves an
interaction between the two systems. Implicit processing is posited to
maintain current mood by gathering mood-congruent information 1.1.1. Attention
until an affective threshold is reached. At that time, explicit processing Automatic attention allocation reflects an individual's goals,
is triggered to restore homeostasis by seeking mood-incongruent emotions, moods, and task demands, and is greatly influenced by
information. In line with this model, Beevers (2005) proposed that prior experience (Hertel, 2002). Therefore, individuals with negative
depression occurs when negatively biased implicit processing self-views may preferentially respond to negative self-referential
W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709 693
environmental cues. In a cyclical fashion, such selective attendance visual tasks (e.g., Siegle, Ingram, & Matt, 2002) and others have failed
may maintain depressed mood and serve to substantiate and to detect biases after long exposures (e.g., Yovel & Mineka, 2004).
consolidate detrimental self-related cognitions. Depression research The tendency to observe biases at longer stimulus durations
has assessed biases in three identified subsystems of attention: suggests that depression may not be associated with preferential
shifting, engagement and disengagement (Posner, Inhoff, Friedrich, & attentional shifting toward negative self-referential stimuli, but with
Cohen, 1987). sustained attention to it (Mogg & Bradley, 2005; Wisco, 2009) that
Hypothesized biases in orienting attention toward negative self- may reflect an inability to disengage from it (Gotlib & Joormann,
related stimuli have been assessed by a variety of tasks. Probe tasks 2010; Wisco, 2009). Probe tasks are ill-equipped to assess this
provide relatively direct measures of shifts in attention towards the possibility because they provide only a broad measure of attentional
location of emotional stimuli. Stimuli usually comprise negative and bias (Koster, De Raedt, Goeleven, Franck, & Crombez, 2005). The
neutral (and/or positive) trait and/or state self-descriptive adjectives. Exogenous Cuing Task (Posner, 1980) addresses this limitation by
Pairs of stimuli are presented (e.g., one negative and one neutral) and varying cue-target intervals to provide separate indicators for
participants are required to respond rapidly to a probe stimulus (e.g., engagement and inhibition aspects of attention. A valenced target
a dot or symbol) that replaces one cue. Negative attentional biases are stimulus appears in either the same or opposite spatial location as a
indicated by faster reaction times (RTs) to negative than to neutral preceding prime stimulus. Participants respond faster when the
cues. Short stimulus durations (e.g., up to 500 ms) have been used to valence of prime and target coincide at short intervals (i.e., cue
measure early stage orienting processes, whereas longer stimulus validity), whereas the effect disappears or reverses at longer
durations (e.g., 1000 ms) have been employed to assess sustained intervals because attention is inhibited in favour of new locations.
attentional processing. The emotional modification of this task involves comparing
In the deployment-of-attention task (DOAT), a negative and a responses to emotional versus neutral words. Negative biases may
neutral (or positive) word are simultaneously replaced with bars of be observed by extended cue validity effects for negative words,
different colors. Participants are misinformed that the bars appear faster engagement to negative words on valid trials and/or slower
sequentially and asked to report which color appears first. disengagement from them on invalid trials.
Perception of the color bar that replaces the previously-attended Using the exogenous cuing paradigm, Koster et al. (2005) found
word will precede perception of the other bar. Thus, negative biases that dysphoric undergraduate participants were significantly slower
are observed when colors that replace negative words are identified to disengage attention from negative self-referential words than non-
more often than colors that replace neutral words. This task's forced- dysphoric participants, but only at long stimulus presentations.
choice format avoids possible confounds of motivational and Research using other methods has also suggested that depression is
response speed factors that may differentiate groups in RT tasks associated with impaired disengagement from negative information
(McCabe, Gotlib, & Martin, 2000). This is particularly relevant to (Gotlib & Joormann, 2010). For example, Rinck and Becker (2005)
depression research, where affected individuals typically exhibit found that depressed participants were not characterized by
symptomatic cognitive impairment (Pelosi, Slade, Blumhardt, & enhanced detection of negative words in a word matrix but were
Sharma, 2000). more easily distracted by them. Difficulty disengaging from negative
Other tasks have used interference effects to measure automatic stimuli may sustain depressed mood by increasing the availability
attentional processes. In the Dichotic Listening Task, participants are of negative information and the likelihood of rumination (Donaldson
asked to repeat information presented to one ear and ignore et al., 2007).
information presented to the other ear. Negative self-referential biases Researchers have hypothesized that depression-related difficulties
are hypothesized to interfere with the ability to ignore the unattended in disengaging attention from negative information may reflect
channel when negative stimuli are presented. Thus, attentional biases deficits in cognitive inhibition. Inhibition aspects of attention have
are observed when negative words presented to the unattended ear been investigated using negative affective priming (NAP; Joormann,
are associated with slower RTs or with greater numbers of shadowing 2004). In this task, two consecutive trials are presented, each of which
errors than contrast words. Similarly, the Emotional-Stroop task contains a target word and a distractor word (e.g., positive or
requires participants to identify the color of presented words while negative). For each display, participants are required to name the
ignoring their meaning. Attentional biases are inferred from slower target and ignore the distractor. A negative bias is indicated by faster
color-naming latencies for negative compared to neutral words, with response latencies to negative targets that follow negative distractors
the assumption that the word's meaning has interfered with the on previous trials. Using NAP, Joormann (2004) found that non-
participants' ability to color-name. However, the Stroop has been dysphoric participants were slower to identify the valence of positive
criticized as a measure of attentional bias because differences in and negative adjectives following similarly-valenced distractors,
interference may be due to either input (attentional) or output whereas dysphoric participants inhibited only positive distractors
(response) processes (Gotlib, Neubauer Yue, & Joormann, 2005). and demonstrated faster responses to negative adjectives presented
Reviewers of the attentional bias literature have noted that after negative distractors (i.e., indicating ineffective inhibition).
depressive biases for negative stimuli tend to be found at longer, Similar methods have facilitated the detection of deficits in other
rather than shorter, stimulus presentations (Gotlib & Joormann, 2010; aspects of inhibition in depression, such as removing negative
Mogg & Bradley, 2005; Wisco, 2009). For example, Mogg, Bradley, and information from working memory (e.g., modified Sternberg Task;
Williams (1995) conducted a dot-probe task involving pairs of Joormann & Gotlib, 2008).
negative (or positive) and neutral words at subliminal (14 ms) and
supraliminal (1000 ms) stimulus durations. Compared to controls, 1.1.2. Memory
depressed participants were significantly faster to detect probes that Implicit memory is usually defined as an unintentional process in
replaced negative words only in the supraliminal condition. Other dot which “performance on a task is facilitated in the absence of conscious
probe studies have reported similar results (e.g., Bradley, Mogg, & Lee, recollection” (Graf & Schacter, 1985, p. 501). Associative memory
1997; Donaldson, Lam, & Mathews, 2007; Mathews, Ridgeway, & networks are believed to operate in a bidirectional fashion (Bower,
Williamson, 1996), and subliminal presentations of stimuli in 1981); where affective states influence memory processes and
Emotional Stroop tests have also failed to reveal depressive biases memories influence affect. Thus, activated connections between
(Lim & Kim, 2005; McNeely, Lau, Christensen, & Alain, 2008; Yovel & negative emotions, arousal, and episodic information may affirm
Mineka, 2005). However, it should be noted that some studies have negative self-schema and perpetuate dysphoria. A recall bias for
found depression-related biases after short stimulus exposures on positive self-referential information represents the normative baseline
exhibited by non-depressed groups, whereas depressed individuals be confounded by inclusion of several Lexical Decision Task studies in
exhibit biases toward negative information and/or away from positive the perceptual category, which may be inappropriate because
information (Matt, Vázquez, & Campbell, 1992). Depression research- semantic content has been shown to influence task performance
ers have sought to identify similar depression-related biases in implicit (Neely, 1977). Conversely, these theorists have argued that conscious
memory by assessing the recognition of valenced environmental elaboration underlies implicit memory (Williams, Watts, MacLeod, &
stimuli. Mathews, 1997) and that depressive biases will only emerge if
Implicit recognition biases are typically measured by priming, conceptual processing is employed at the time of encoding and
where responses indicate exposure to previously encoded material. retrieval (Watkins, 2002; Wisco, 2009). Thus, controversy continues
Word completion tasks involve the initial presentation of a list of to surround the level of processing required to demonstrate implicit
negative and positive words under an encoding condition. Later, memory biases in priming tasks.
participants are given a list of word stems or fragments and asked to At least one study has investigated existence of biases in implicit
complete each one with the first word that comes to mind. No autobiographical memory in depression (e.g., MacLeod, Tata, Kentish,
reference is made to the encoding session. Half can be completed to & Jacobsen, 1997). Whereas implicit recognition tests involve
form words from the encoded list (primed words), and half can form unconscious processes, autobiographical memory tasks may be
words from a new list (unprimed words). The difference between the considered implicit if the measurement outcome involves rapid
number of primed and unprimed negative words completed provides processing. For example, participants may be required to report as
an index of negative bias. Similarly, the difference between primed many positive or negative memories as they can within a limited
and unprimed positive words completed indicates degree of positive timeframe.
bias. Alternative retrieval paradigms have included providing word
associations to experimental cues (Watkins, Martin, & Stern, 2000), 1.1.3. Interpretation and self-beliefs
creating words from anagrams (Ellwart, Rinck, & Becker, 2003), or Depression is associated with a set of maladaptive beliefs,
naming positive or negative words aloud (i.e., word identification). including perfectionistic self-standards, personal inadequacy, rejec-
Priming also features in the most commonly used RT measure of tion by others, self-blame for negative outcomes, and pessimistic
implicit memory; the Lexical Decision Task. In this task, lexical stimuli personal future-event predictions (Wisco, 2009). Our interpretations
(comprising words and non-words) are briefly presented, masked, of experiences, interactions, and stimuli are largely determined by our
and then presented again. Upon the second presentation, participants belief system. Thus negative self-beliefs may underlie an interpretive
are required to identify whether each stimulus is a legitimate (e.g., bias in depression, in which ambiguous information is processed in an
English) word by indicating “yes” or “no” as quickly as possible. Faster unrealistically negative self-referential manner. In turn, negative
responses to positive than to neutral words indicate a positive implicit interpretations may reinforce self-beliefs and amplify negative mood.
memory bias and faster responses to negative than to neutral words Very few methods have been developed to assess implicit self-
indicate a negative bias. beliefs and interpretive biases. The most widely used measure is the
Despite the importance of the hypothesized role of implicit Scrambled Sentences Test (SST; Wenzlaff, 1993), which evaluates
memory in depression, literature reviewers have reported inconsistent participants' tendencies to interpret ambiguous information (e.g.,
observations of depression-related biases (e.g., Gotlib & Joormann, “winner born I am loser a”) as a positive (“I am a born winner”) or a
2010; Watkins, 2002; Wisco, 2009). Several cross-sectional studies of negative (“I am a born loser”) self-belief. Participants are presented
depressed and non-depressed participants have found strong negative with a series of scrambled sentences and asked to use five of the six
biases amongst depressed participants (e.g., Bradley, Mogg, & Williams, words to create the first grammatically correct sentence that comes to
1994; Bradley, Mogg, & Millar, 1996; Ruiz-Caballero & González, mind. The task is completed under time pressure and a neutral
1994;1997). For example, Ruiz-Caballero and González (1997) found condition may be included to obscure the purpose of the task.
that, compared to non-depressed participants, depressed participants Percentage of negative solutions provides an index of negative
completed more word-stems with primed than with unprimed negative interpretive bias. Wenzlaff, Rude, Taylor, Stultz, and Sweatt (2001)
words and fewer word-stems with primed than with unprimed positive expressed concern over the implicitness of the SST due to its relative
words. However, a similar number of studies have failed to observe transparency and the potential for participants to consciously control
significant group differences (e.g., Danion, Kauffmann-Muller, Grangé, their responses. However, the SST has been included in this meta-
Zimmerman, & Greth, 1995; Denny & Hunt, 1992; Ilsley, Moffoot, & analysis because it meets two alternative implicitness criteria: fast
O'Carroll, 1995; Watkins, Mathews, Williamson, & Fuller, 1992). and efficient (cf. Inclusion criteria; see De Houwer & Moors, 2010).
Two explanations for the inconsistencies in the implicit memory Other interpretive bias measures have included asking individuals
literature have been proposed. Barry, Naus and Rehm (2004) to write down verbally-presented homophones that could be
suggested that implicit memory biases will only appear if the same interpreted as negative or neutral words (Wenzlaff & Eisenberg,
level of processing is employed during both encoding and retrieval 2001); to unknowingly convey personal interpretations of stories that
tasks. Referred to as transfer-appropriate processing (TAP), this view could be either positive or negative (i.e., disambiguated stories,
predicts that either perceptual processing or conceptual processing Halberstadt et al., 2008); or to indicate whether they recognise
must be activated at both times. Perceptual processing refers to data- disambiguated positive or negative sentences that they previously
driven processing that may occur without awareness of semantic viewed as unvalenced sentences (Wenzlaff, Meier, & Salas, 2002).
content (e.g., counting letters in words), whereas conceptual proces- Generally, reviewers have reported that implicit interpretation
sing involves the effortful analysis of stimulus meaning (e.g., rating research in depression is scarce and the results equivocal (e.g., Gotlib
pleasantness of words). Barry et al.’s (2004) review of the implicit & Joormann, 2010; Wisco, 2009). However, studies that have failed to
memory literature found that almost all studies conformed to the TAP observe implicit interpretive biases in depression have tended to use
framework. Depression-related negative biases were observed in ambiguous stimuli that was not self-related (e.g., Lawson & MacLeod,
most studies that used perceptual (e.g., Ruiz-Caballero & González, 1999). The specificity of negativity toward the self in depression, as
1997) or conceptual (e.g., Watkins, Vache, Verney, Muller, & Mathews, opposed to general or other-related negativity, has been demonstrat-
1996) encoding and retrieval strategies, whereas biases were not ed empirically (Wisco, 2009). Accordingly, most interpretation
found in most studies that used a combination of perceptual and studies that have employed self-referential stimuli have found
conceptual tasks (e.g., Denny & Hunt, 1992). reliable and strong negative biases amongst depressed individuals.
Other theorists have challenged the TAP account (e.g., Watkins, For example, high scores on the SST have discriminated depressed and
2002; Wisco, 2009). They contend that evidence supporting TAP may formerly depressed groups from never depressed groups in cross-
sectional studies (Hedlund & Rude, 1995; Rude, Covich, Jarrold, “no” key. Lower self-esteem is indicated by shorter latencies to make
Hedlund, & Zentner, 2001), and prospectively predicted subsequent “yes” judgements to negative attributes and “no” judgements to
depressive symptoms (Rude, Valdez, Odom, & Ebrahimi, 2003) and positive attributes.
depression diagnosis (Rude, Wenzlaff, Gibbs, Vane, & Whitney, 2002) An alternative mode of implicit self-esteem estimation is offered
of undergraduates. by the Name Letter Preference Task (NLPT; Nuttin, 1985). The NLPT is
Pessimistic personal future-event beliefs have also been reliably based on the finding that people with high self-esteem tend to prefer
observed in depression, in the form of a surplus of expectancies for the letters in their own name more than people with low self-esteem
negative events and/or a shortage of positive expectancies (e.g., like their name-letters (Nuttin, 1987). Preference for initials can be
Lavender & Watkins, 2004; MacLeod & Salaminiou, 2001). These considered an implicit index of self-esteem because people are
beliefs may become automated through habitual thinking styles generally unaware that they possess or display such a preference
(Andersen & Limpert, 2001; Andersen, Spielman, & Bargh, 1992). (Greenwald & Banaji, 1995; Koole et al., 2001). In the task, each letter
Specifically, well rehearsed ruminative thought patterns may create of the alphabet is briefly presented in the centre of a computer screen
associative structures that facilitate the effortless production of and participants are required to rate their immediate response to the
negative predictions and an unwavering certainty of their inevitabil- letter (e.g., not at all attractive to very attractive). Lower self-ratings
ity. In contrast, non-depressed individuals make more positive and for one's own name-letters (or initials) compared to others' ratings of
realistically uncertain future predictions. Future-event schemas have those letters indicates negative self-esteem.
been assessed by tasks involving time pressure. For example, the Investigations into the relationship between depression and
Personal-Future Task (MacLeod, Tata, et al., 1997) requires partici- implicit self-esteem are relatively recent and have not yet been
pants to envisage positive and/or negative experiences that may evaluated by literature reviewers. As predicted by cognitive theories
happen to them in the future, and to generate as many as possible of depression, several cross-sectional studies have identified low
within a brief time (e.g., 30 s). Response latencies to identify implicit self-esteem amongst depressed participants (e.g., Franck, De
examples, or predict the likelihood, of specific future events have Raedt, Dereu, & Van den Abbeele, 2007; Segal, Truchon, Gemar,
also been utilized (Andersen et al., 1992; MacLeod & Cropley, 1995). Guirguis, & Horowitz, 1995). For example, Gilboa, Roberts and Gotlib
(1997) found that dysphoric undergraduate participants were faster
1.1.4. Self-esteem to affirm negative self-descriptors and slower to reject positive self-
Explicit and implicit self-esteem are believed to represent two descriptors on the SDJT than non-dysphoric participants; including
distinct self-attitudes. Whereas explicit self-esteem comprises con- those who were experiencing an experimentally-induced sad mood
sciously-held attitudes toward the self, implicit self-esteem is posited that was equivalent to that of dysphoric participants. Low scores on
to reflect automatic associations between self-concept and positivity the Self-worth IAT have also predicted subsequent levels of depressive
or negativity that developed during early experiential learning (Koole, symptoms of undergraduates (Haeffel et al., 2007). However, the
Dijksterhuis & van Knippenberg, 2001; Rudman, 2004). Of particular results of other studies have led some researchers to suggest that
relevance to depression, implicit self-esteem has predicted self- depression is associated with paradoxically positive implicit self-
reported levels of daily negative affect over and above the influence of esteem (De Raedt, Schacht, Franck, & De Houwer, 2006). De Raedt
explicit self-esteem (Conner & Feldman Barrett, 2005). et al. (2006) found that clinically depressed participants' scores on the
Implicit self-esteem is often assessed by the Implicit Association IAT and NLPT revealed similarly positive self-esteem to controls, and
Test (Self-worth IAT; Greenwald & Farnham, 2000). The Self-worth their scores on the EAST indicated significantly higher self-esteem
IAT measures the relative strength of associations between four than controls.
stimulus categories: “me” (e.g., own name), “not-me” (e.g., other
name), “negative” (e.g., sad), and “positive” (e.g., happy). Words from
the four categories are presented individually on a computer screen, 1.2. Study design
and participants assign each item to its target category. In one
condition, pressing one key categorizes “me” and “positive” items and Most research on depression-related cognitions has involved
another key classifies “not-me” and “negative” items. In a comparison cross-sectional designs to identify differences between depressed
condition, one key is pressed for “me” and “negative” pairings and the and non-depressed individuals (Abramson et al., 2002; Ingram et al.,
other key classifies “not-me” and “positive” attributes. Responses are 1998; Scher et al., 2005). However, cross-sectional designs cannot
faster when the pairings of target and attribute items match an fully address vulnerability assumptions of cognitive models of
individual's automatic associations. Consequently, negative implicit depression. To provide empirical support for a hypothesized cognitive
self-esteem is indicated by shorter response latencies to categorize vulnerability, a study design should also demonstrate that the
“me” and “negative” than “me” and “positive” attributes. cognition temporally precedes the initial onset or recurrence of
The Extrinsic Affective Simon Task (De Houwer, 2003) involves the depression (Ingram et al., 1998) and is not a temporary consequence
classification of colored adjectives. In self-esteem studies, white or symptom of the disorder (Riskind & Alloy, 2006).
descriptive adjectives are categorised according to their valence (e.g., In this respect, designs that compare formerly- and non-depressed
“L” if positive and “S” if negative) and colored words relating to self or groups (i.e., Remitted designs) are more informative because they can
other are classified according to their color (e.g., “L” if blue and “S” if establish independence of vulnerabilities from symptoms. But, like
green). The EAST is based on the assumption that performance is cross-sectional studies, remitted designs cannot determine whether
facilitated when items associated in memory share a response key. scores on cognitive measures reflect consequences or scars of
However, evidence suggests that this facilitative effect is moderated depression, rather than risk factors or causes (Lewinsohn, Steinmetz,
by affective state (Vermeulen, Corneille, & Luminet, 2007). Specifi- Larson, & Franklin, 1981). Prospective designs that measure hypoth-
cally, the EAST effect appears to be positively correlated with positive esized cognitive vulnerability factors prior to depression onset are
affective states and negatively correlated with negative affective often considered most suitable for assessing vulnerability hypotheses
states. Consequently the EAST may lack validity when used to assess because they can establish both temporal precedence and indepen-
the attitudes of depressed individuals. dence from symptoms. To date, prospective research on implicit
Compared to the IAT and EAST, the Self-Descriptiveness Judge- cognition in depression is sparse. Some high-risk designs perform the
ment Task (SDJT) provides a relatively simple RT estimate of implicit same function: These designs assess whether hypothesised vulnera-
self-esteem. Participants are asked to indicate whether trait adjectives bility factors (e.g., familial, social or cognitive) predict subsequent
displayed on a screen describe their personality by pressing a “yes” or depression.
If negative self-referential implicit cognitions represent vulnera- Mogg & Bradley, 2005) and across (e.g., Joormann, 2009; Wisco, 2009)
bility factors for depression, they should (theoretically) predict past, cognitive domains.
current and future depression. If so, this meta-analysis should find Existing narrative reviews have not quantified the predictive
significant relationships between implicit cognitions and depression, ability of implicit cognition across studies. Thus, their conclusions
on average, in studies that have used remitted, cross-sectional and reflect a preponderant weighing of results from studies that used
prospective designs. different methodologies, populations, and researchers. Consequently,
Another methodological issue surrounds the validity of research differences between studies and across cognitive domains may reflect
using undergraduate samples, which reflects ongoing debate about superficial methodological aspects rather than the presence or
whether depression operates in a categorical or dimensional fashion absence of the bias of interest. Additionally, these reviews relied on
(Ruscio, Brown, & Ruscio, 2009; Ruscio & Ruscio, 2000). From a statistical significance tests where results were reported as either
dimensional perspective, depression occurs on a continuum and supporting or failing to support a hypothesized relationship. Howev-
schematic processing is a normative process that differs only in er, statistical significance is influenced by sample size and does not
valence and intensity between individuals. From a categorical indicate the strength or magnitude of observed effects. Although
viewpoint, clinically depressed individuals possess qualitatively meta-analytic studies take sample size into account and can provide
different cognitions from non-depressed individuals. In relation to effect size estimates, only one previous meta-analysis has assessed
this meta-analysis, the categorical perspective suggests that different implicit depression-related cognition; specifically, attention biases
effects will be found in clinical compared to non-clinical studies observed in a subsample of Lexical Decision Task studies (Siegle,
whereas the dimensional account predicts that similar effects will be 1996). Several other meta-analyses have focussed on related issues
observed in all sample types. such as explicit biases (e.g., Matt et al., 1992) and emotional reactivity
(Blysma, Morris, & Rottenberg, 2008) in depression.
1.3. Cognitive reactivity and control The current meta-analysis reviewed empirical studies that have
assessed the relationship between negatively biased self-referential
Cognitive theories of depression are essentially diathesis-stress implicit cognitions and depression. We aimed to determine: (1)
models, in which negative self-referential biases are posited to remain whether a reliable relationship exists between negative self-referential
dormant until activated by relevant environmental cues, such as implicit cognition and depression, and (2) if that relationship is
stress or sad mood (e.g., Beck, Rush, Shaw, & Emery, 1979; Beevers, moderated by four factors: facet of cognition, reactivity and control,
2005). Cognitive reactivity refers to the relative ease with which sample type, and measurement strategies. We also aimed to assess
maladaptive cognitions are activated in vulnerable individuals. whether priming thresholds moderate the relationship between
Consequently, researchers have utilized priming procedures (e.g., attentional bias and depression, and if level of processing at encoding
sad mood inductions) to activate and identify latent biases. Support- and retrieval moderates effect sizes across implicit memory studies.
ing theoretical predictions, several studies have revealed negative Results of these analyses may elucidate the nature of the
self-schemas amongst formerly depressed individuals after, but not relationship between implicit cognitive biases and depression. From
before, a sad mood induction (Scher et al., 2005). a theoretical perspective, these results will indicate the degree of
From a dual process perspective, a sad mood induction may expose support for dual-process and diathesis-stress models of depression.
latent self-schema by increasing maladaptive bottom-up processing Specifically, these models will be supported if: 1) all facets of
or by undermining regulatory functions of top-down processing cognition are equally strong predictors of depression, 2) implicit
(Hartlage et al., 1993). Vulnerable individuals may successfully negative biases predict depression in cross-sectional, remitted and
override implicit negative biases when sufficient cognitive resources prospective studies, and 3) experimental cognitive manipulations
are available, but their ability to self-regulate may be impaired when strengthen the relationship between implicit biases and depression.
cognitive resources are depleted (e.g., by life stress). For example, From a methodological perspective, these results may assist future
evidence suggests that the dispositional tendency to suppress researchers and practitioners to utilize appropriate samples and
unwanted thoughts may perform a protective function at low levels reliable measures. From an applied perspective, these results may
of life stress, but may present an increased risk for depression as life provide information to guide the development of more effective
stress increases (Beevers & Meyer, 2004). Consequently, in order to treatments.
uncover negative implicit cognitions, researchers have employed
dual-task (e.g., cognitive load) procedures to deplete participants' 2. Method
cognitive resources and disrupt their mental control efforts during
task completion. For example, participants may be required to 2.1. Literature search
memorise and retain a six digit number while simultaneously
completing the task of interest. Studies were primarily sourced from the PsychINFO and PubMed
According to schema and dual process models of depression, the databases using two categories of keywords. The first category of
relationship between negative implicit self-referential cognitions and search terms included depression, depressive, depressed, dysphoria
depression should be strongest, on average, under conditions that and dysphoric. Search terms in the second category related to implicit
maximize the potential activation of implicit processing and/or inhibit measures and cognitive biases: implicit, automatic, indirect, schema,
the potential for corrective explicit processing. One of the aims of the attention, attentional bias, memory, memory bias, interpretation,
current meta-analysis is to assess the validity of this premise. interpretive bias, beliefs, self-esteem, self, future, cognitive bias, dot
probe, visual probe, dichotic listening, Stroop, word stem, word
1.4. Rationale for this meta-analysis fragment, word completion, homophones, lexical decision, priming,
scrambled sentences, Implicit Association Test, name letter prefer-
According to most cognitive theories (e.g., Beck, 1967; Beevers, ence, Extrinsic Affective Simon, and Go/No Go. The search was limited
2005), implicit cognitive biases resulting from activated negative to contemporary methodologies reported in articles published from
self-schemas should be evident across all cognitive domains (e.g., 1984 to the present. We limited the literature search to 25 years to
attention or memory) and measurement paradigms. However, keep the scope of the study manageable and because of difficulties
literature reviewers have indicated tenuous support for this predic- acquiring data for older studies. Articles that contained one search
tion, by noting apparently inconsistent relationships between term from each category were sourced for potential inclusion, and
depression and implicit biases both within (e.g., Barry et al., 2004; their references were checked to identify additional relevant studies.
2.2. Inclusion criteria request. Several studies were excluded because this information could
not be obtained.1 Three studies were excluded because their datasets
To be included, studies were required to involve an assessment of an were utilized in subsequent studies that were included in this meta-
implicit cognitive bias in attention, memory, self-esteem, interpretation analysis (i.e., Neshat-Doost, Taghavi, Moradi, Yule, & Dalgleish, 1997;
or self-beliefs and a measure of naturally-occurring depressive Neshat-Doost, Moradi, Taghavi, Yule, & Dalgleish, 2000; Rude et al.,
symptoms and/or clinical status. 2003). When a study reported a non-significant result but did not
provide sufficient information to determine an effect size, we entered
2.2.1. Stimuli zero as the effect size (see Table 1). Two hundred and two effect sizes
In accordance with cognitive theories, studies were required to were acquired from 89 samples, resulting in a pooled sample size of
utilize self-referential experimental stimuli, including affective state 7032 with a mean age of 32. See Table 1 for a summary of included
or trait self-descriptors, perceptions of self-worth, and beliefs about studies.
one's past, present and future life. Accordingly, studies that used
facial, physical, or general threat stimuli were excluded (e.g., horror 2.3. Moderator coding
and accident). We also excluded neuro-imaging and neurophysiolog-
ical studies to confine this study within manageable boundaries. Effect sizes were coded by four potential primary moderators:
2.2.2. Samples and depressive status 2.3.1. Aspect of cognition

While no age-groups were deliberately excluded, all retained studies Effect sizes were classified into four groups according to the facet
used adult samples except for one (Mean age = 15.37; Dalgleish et al., of cognition they assessed: attention, memory, interpretation/beliefs,
2003). To be included, studies were required to involve samples that and self-esteem. Effect sizes were calculated to represent observed
included individuals who exhibited or reported at least mild levels of relationships between depression and negative cognitive biases;
current or previous depression (e.g., BDI-II≥ 14, Beck, Steer, & Brown, where positive effect sizes represented relationships between higher
1996) as well as individuals who reported low levels of depressive levels of depression and larger attentional biases toward negative
symptoms. Mildly depressed groups were included because around 50% stimuli, greater memory for negative stimuli, lower self-esteem, or
of depression research has involved undergraduate samples that rarely higher levels of negative interpretive biases and self-beliefs. Following
comprise severely depressed individuals. Comparisons with other theory and convention, negative biases for negative and positive
clinical groups were excluded. stimuli were included in the memory and interpretation/beliefs
categories if both statistics were available. Efforts were made to
2.2.3. Implicitness extract statistics that assessed conceptually equivalent constructs
De Houwer and colleagues (De Houwer & Moors, 2007; De Houwer, within each facet of cognition. When a study provided separate
Tiege-Mocigemba, Spruyt, & Moors, 2009) defined implicit measures as statistics for positive and negative components of a self-esteem
measurement outcomes produced by psychological attributes via measure, we averaged the two resulting effect sizes to estimate the
automatic processes; where automatic processes are processes that can measure's typical single measurement outcome (see Table 1). For all
operate under uncontrolled, goal independent, unconscious, efficient or studies, when ideal figures were not available and alternative
fast conditions. A measure may be considered uncontrolled if the attribute calculation methods could be applied (e.g., frequencies or chi square),
still causes the measurement effect even when participants intend to we chose the method that produced the lower effect size estimate.
prevent, alter, or avoid expressing the attribute via the measure. A
process is goal-independent when its occurrence does not causally
2.3.2. Cognitive reactivity and control
depend on participants adopting any type of methodological goal.
Studies were classified into four categories according to their use
Unconscious measures assess an attribute when participants are unaware
of conditions that manipulated participants' cognitive reactivity and
of the activating stimuli, the attribute itself, or that (or how) the attribute
control: none, sad mood induction, cognitive load, and sad mood
influences performance. Efficient measures consume little or no proces-
induction and cognitive load. Rumination and self-focus manipula-
sing resources or attentional capacity, as evidenced by an effect when
tions were classified as mood inductions because evidence suggests
resources are restricted by time or cognitive load. Finally, processes are
that rumination inductions lower participants' moods (Lavender &
fast if the effect occurs when stimulus input and/or process duration are
Watkins, 2004; Nolen-Hoeksema & Morrow, 1993) and self-focus
relatively brief (as determined by the specific task). For a comprehensive
inductions enhance accessibility of self-related constructs in long-
account, see Moors, De Houwer and colleagues (De Houwer & Moors,
term memory (Hedlund & Rude, 1995).
2010; Moors & De Houwer, 2006; Moors, Spruyt, & De Houwer, 2010).
From this decompositional view, implicit measures can be implicit
in different ways and individual automaticity features may not 2.3.3. Sample type
necessarily co-exist within a particular measure (De Houwer et al., Categories of samples included clinical, undergraduate, and
2009). For example, in relation to the IAT, participants have minimal community.
control over the measurement outcome (e.g., Steffens, 2004) but may
be aware of the attribute being assessed (e.g., Monteith, Voils, & 2.3.4. Measurement strategy
Ashburn-Nardo, 2001). Thus, an IAT can be considered implicit in the To increase power, some tasks were grouped (as indicated)
sense of uncontrolled but not unconscious (De Houwer, 2009). according to methodological similarities. Effect sizes within these
Conversely, the goal of the SST is relatively transparent and responses groups were homogenous. Twenty-three measurement strategy
may be controlled, but it is efficient because its effect increases when categories were coded: Deployment of Attention Task, dichotic
completed under cognitive load (Wenzlaff & Bates, 1998). Studies listening, Extrinsic Affective Simon Task, Exogenous Cuing Task,
selected for this meta-analysis used measures that were judged to negative affective priming/Sternberg Task, probe tasks (dot probe and
possess at least one automatic feature, as indicated by empirical visual probe), Stroop, valence identification, visual search, Imbedded
evidence or deduction (Moors et al., 2010). Word Task, Implicit Association test, Name Letter Preference Task,
Self-Descriptiveness Judgement Task, Breadth-based Adjective Rating
2.2.4. Statistics Task, Lexical Decision Task, word completion (word stems and word
Appropriate statistics (e.g., means and standard deviations) were
required to be reported in the article or available from the author upon 1
A list of excluded studies and conditions is available from the authors.
698
Table 1
Summary of included studies.
Author N Sample type M age Study design Aspect of cognition Measurement strategy Priming and Cognitive reactivity Implicitness r SE
processing and control of measure
Andersen and Limpert (2001) 37 Undergraduate 19 Cross sectional Interpretation/beliefs (pos) Personal-future – Cog Load EF 0.40 0.17
Andersen and Limpert (2001) 37 Undergraduate 19 Cross sectional Interpretation/beliefs (neg) Personal-future – Cog Load EF 0.10 0.17
Andersen et al. (1992) 53 Undergraduate – Cross sectional Interpretation/beliefs (neg) Yes/no future – Cog Load EF 0.29 0.14
Andersen et al. (1992)b 32 Undergraduate – Cross sectional Interpretation/beliefs (neg) Yes/no future – Cog Load EF 0.35 0.19
Andersen et al. (1992)be 32 Undergraduate – Cross sectional Interpretation/beliefs (pos) Yes/no future – Cog Load EF 0.00 0.19
Andersen et al. (1992)e 53 Undergraduate – Cross sectional Interpretation/beliefs (pos) Yes/no future – Cog Load EF 0.00 0.14
Baños, Medina and Pascual (2001) 40 Clinical – Cross sectional Memory (neg) Word stems (combined – None – 0.19 0.16
encoding conditions)
Baños et al. (2001) 40 Clinical – Cross sectional Memory (pos) Word stems (combined – None – 0.08 0.16
encoding conditions)
e
Bradley et al. (1997) Study 2 41 Undergraduate 21 Cross sectional Attention Dot probe (14 ms) ≤400 ms None UCF 0.00 0.16
Bradley et al. (1997) Study 2 41 Undergraduate 21 Cross sectional Attention Dot probe (1000 ms) ≥500 ms None UCF 0.32 0.16
Bradley et al. (1996) Experiment 1 26 Undergraduate 19 Cross sectional Memory (neg) Lexical decision (28 ms) P/P None UGCEF 0.38 0.21
Bradley et al. (1996) Experiment 1 26 Undergraduate 19 Cross sectional Memory (neg) Lexical decision (7 s) P/P None UGCE − 0.04 0.21
W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

Bradley et al. (1996) Experiment 2 30 Clinical 39 Cross sectional Memory (neg) Lexical decision (28 ms & 7 s) P/P None UGCE 0.34 0.19
Bradley et al. (1994) 53 Undergraduate – Cross sectional Memory (neg) Lexical decision (28 ms) P/P None UGCEF 0.28 0.14
Bradley, Mogg and Williams (1995) 37 Clinical 37 Cross sectional Memory (neg) Lexical decision (7 s) P/P None UGCE 0.33 0.17
Bradley et al. (1995) 37 Clinical 37 Cross sectional Memory (pos) Lexical decision (7 s) P/P None UGCE − 0.06 0.17
Bradley et al. (1995) 37 Clinical 37 Cross sectional Memory (neg) Lexical decision (14 ms) P/P None UGCEF 0.24 0.17
Bradley et al. (1995) 37 Clinical 37 Cross sectional Memory (pos) Lexical decision (14 ms) P/P None UGCEF 0.04 0.17
Broomfield, Davies, MacMahon, 39 Clinical 73 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.32 0.17
Ali and Cross (2007)
Dalgleish et al. (2003) 45 Clinical 15 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.00 0.15
Dalgleish et al. (2003) 45 Clinical 15 Cross sectional Attention Dot probe ≥500 ms None UCF − 0.04 0.15
Danion et al. (1995) 60 Clinical 41 Cross sectional Memory (neg) Word stems C/P None CE − 0.05 0.13
Danion et al. (1995) 60 Clinical 41 Cross sectional Memory (pos) Word stems C/P None CE − 0.08 0.13
Denny and Hunt (1992)f 32 Clinical (women) 27 Cross sectional Memory (neg) Word fragments C/P None CE 0.04 0.19
De Raedt et al. (2006) Study 1a 30 Clinical 44 Cross sectional Self-esteem IAT – None UEF − 0.01 0.19
De Raedt et al. (2006) Study 2 32 Clinical 39 Cross sectional Self-esteem NLPT – None UGCEF 0.14 0.19
De Raedt et al. (2006) Study 3 26 Clinical 39 Cross sectional Self-esteem EAST – None UEF − 0.41 0.21
Dudley, O'Brien, Barnett, 24 Clinical 74 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.42 0.22
McGuckin and Britton (2002)
Ellwart et al. (2003) 72 Clinical 42 Cross sectional Memory (neg) Anagrams C/C None CEF 0.17 0.12
Ellwart et al. (2003) 72 Clinical 42 Cross sectional Memory (pos) Anagrams C/C None CEF 0.08 0.12
Franck, De Raedt, Dereu, et al. (2007) 29 Clinical 43 Cross sectional Self-esteem IAT – None UEF 0.59 0.16
Franck, De Raedt, Dereu, et al. (2007) 30 Clinical (suicidal) 41 Cross sectional Self-esteem IAT – None UEF 0.14 0.13
Franck, De Raedt and De Houwer (2007) 61 Clinical 42 Cross sectional Self-esteem NLPT – None UGCEF 0.04 0.13
Franck, De Raedt and De Houwer (2007) 67 Clinical 45 Remitted Self-esteem NLPT – None UGCEF 0.00 0.20
Franck, De Raedt and De Houwer (2007) 40 Clinical – Prospective Self-esteem NLPT – None UGCEF − 0.21 0.19
Garlipp (2004)a 30 Undergraduate 41 Cross sectional Self-esteem IAT – None UEF 0.26 0.19
Gemar et al. (2001)a 50 Clinical 38 Remitted Self-esteem IAT – None UEF − 0.10 0.15
Gemar et al. (2001)a 50 Clinical 38 Remitted Self-esteem IAT – Mood UEF 0.07 0.15
Gilboa et al. (1997) Naturally Dysphoric 76 Undergraduate – Cross sectional Self-esteem SDJT (RT affirm) – None UEF 0.59 0.12
Gilboa et al. (1997) Naturally Dysphoric 76 Undergraduate – Cross sectional Self-esteem SDJT (RT reject) – None UEF 0.55 0.12
Gotlib et al. (2004) 143 Clinical 34 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF − 0.05 0.09
(sad word condition)
Gotlib et al. (2004) 143 Clinical 34 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.09 0.09
(social threat condition)
Gotlib, McLachlan and Katz (1988) 24 Undergraduate 32 Cross sectional Attention DOAT (730 ms) ≥500 ms None UCEF 0.36 0.22
Gotlib et al. (2005) 36 Undergraduate – Cross sectional Attention NAP (interference, 100 ms) ≤400 ms None GCEF 0.47 0.17
Gotlib et al. (2005) 36 Undergraduate – Cross sectional Attention NAP (inhibition, 100 ms) ≤400 ms None GCEF 0.35 0.17
Greenberg and Alloy (1989) 24 Undergraduate – Cross sectional Self-esteem SDJT (RT only) – None EF 0.32 0.22
Haeffel et al. (2007) Study 1 237 Undergraduate 19 Cross sectional Self-esteem IAT – None UEF 0.07 0.06
Haeffel et al. (2007) Study 2 251 Undergraduate 19 Cross sectional Self-esteem IAT – None UEF 0.08 0.06
Haeffel et al. (2007) Study 2 251 Undergraduate 19 Prospective Self-esteem IAT – None UEF 0.20 0.07
Halberstadt et al. (2008) 1006 Undergraduate – Cross sectional Interpretation/beliefs (neg) Disambiguated stories – None CE 0.24 0.03
Halberstadt et al. (2008) 1111 Undergraduate – Cross sectional Interpretation/beliefs (neg) Disambiguated stories – None CE 0.07 0.03
(dysphoric)
Halberstadt et al. (2008) 1006 Undergraduate – Cross sectional Interpretation/beliefs (pos) Disambiguated stories – None CE 0.33 0.03
Halberstadt et al. (2008) 1111 Undergraduate – Cross sectional Interpretation/beliefs (pos) Disambiguated stories – None CE 0.05 0.03
(dysphoric)
Halberstadt et al. (2008)b 229 Undergraduate – Cross sectional Interpretation/beliefs (pos) Disambiguated stories – None CE 0.29 0.07
Halberstadt et al. (2008)b 229 Undergraduate – Cross sectional Interpretation/beliefs (neg) Disambiguated stories – None CE 0.18 0.07
Hedlund and Rude (1995) 38 Clinical 33 Cross sectional Interpretation/beliefs SST – Mood EF 0.57 0.17
Hedlund and Rude (1995) 33 Clinical 31 Remitted Interpretation/beliefs SST – Mood EF 0.12 0.18
Hedlund and Rude (1995)e 38 Clinical 33 Cross sectional Attention Emotional Stroop ≥500 ms Mood UCEF 0.00 0.17
Hedlund and Rude (1995)e 33 Clinical 31 Remitted Attention Emotional Stroop ≥500 ms Mood UCEF 0.00 0.18
Hill and Knowles (1991)e 24 – – Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.00 0.22
Ilsley et al. (1995) 30 Clinical 46 Cross sectional Memory (neg) Word stems C/P None CE − 0.07 0.19
Ilsley et al. (1995) 30 Clinical 46 Cross sectional Memory (pos) Word stems C/P None CE − 0.13 0.19
Ingram and Ritter (2000) 34 Undergraduate – Remitted Attention Dichotic listening – None CF 0.00 0.17
Ingram and Ritter (2000) 39 Undergraduate – Remitted Attention Dichotic listening – Mood CF 0.49 0.18
Ingram et al. (1994)d 89 Undergraduate 20 Remitted Attention Dichotic listening – None CF 0.03 0.11

Ingram et al. (1994)d 89 Undergraduate 20 Remitted Attention Dichotic listening – Mood CF 0.12 0.11
Joormann (2004) Study 1 74 Undergraduate 25 Cross sectional Attention NAP ≥500 ms None GCEF 0.26 0.16
Joormann (2004)Study 2 44 Undergraduate 25 Cross sectional Attention NAP ≥500 ms None GCEF 0.29 0.12
Joormann (2004)Study 3 26 Undergraduate 28 Remitted Attention NAP (self reference) ≥500 ms None GCEF 0.34 0.16
Joormann (2004)Study 3 26 Undergraduate 28 Remitted Attention NAP (evaluation) ≥500 ms None GCEF 0.44 0.21
Joormann and Gotlib (2008) 44 Clinical 36 Cross sectional Attention Sternberg Task ≥500 ms None UCEF 0.34 0.21
No sad induction control
Karpinski, Steinberg, Versek 134 Undergraduate – Cross sectional Self-esteem IAT (self-other) – None UEF − 0.01 0.09
and Alloy (2007) Study 2
Karpinski et al. (2007) Study 2 134 Undergraduate – Cross sectional Self-esteem Breadth-based Adjective – None C 0.27 0.09
Rating Task
Kinderman (1994)a 32 Clinical 33 Cross sectional Self-esteem Stroop (Self Worth) – None UCEF 0.11 0.19
Koster et al. (2005) Experiment 1 57 Undergraduate 19 Cross sectional Attention Exogenous cuing ≥500 ms None CF 0.35 0.14
(1500 ms, disengagement)
(1500 ms, engagement)
Koster et al. (2005) Experiment 2 40 Undergraduate 22 Cross sectional Attention Exogenous cuing ≤400 ms None CF 0.07 0.16
Koster et al. (2005) Experiment 2 40 Undergraduate 22 Cross sectional Attention Exogenous cuing ≤400 ms None CF 0.10 0.16
(500 ms, cue validity)
(1500 ms, cue validity)
Lavender and Watkins (2004) 45 Clinical 40 Cross sectional Interpretation/beliefs (pos) Personal-future – Mood EF 0.33 0.15
Rumination condition
Lavender and Watkins (2004) 45 Clinical 40 Cross sectional Interpretation/beliefs (neg) Personal-future – Mood EF 0.38 0.15
Rumination condition
Lim and Kim (2005) 63 Clinical 35 Cross sectional Attention Stroop (subliminal) ≤400 ms None UCEF 0.08 0.13
Negative words condition
Lim and Kim (2005) 63 Clinical 35 Cross sectional Attention Stroop (supraliminal) ≥500 ms None UCEF 0.35 0.13
Negative words condition
699
(continued on next page)
700
Table 1 (continued)
Lim and Kim (2005)c 56 Clinical 35 Cross sectional Memory (neg) Word identification P/P None UCEF − 0.01 0.14
(subliminal)
c
Lim and Kim (2005) 56 Clinical 35 Cross sectional Memory (pos) Word identification P/P None UCEF 0.00 0.14
(subliminal)
c
Lim and Kim (2005) 56 Clinical 35 Cross sectional Memory (neg) Word identification P/P None UCEF − 0.01 0.14
(supraliminal)
Lim and Kim (2005)c 56 Clinical 35 Cross sectional Memory (pos) Word identification P/P None UCEF 0.00 0.14
(supraliminal)
MacLeod and Cropley (1995) 54 Undergraduate 19 Cross sectional Interpretation/beliefs (neg) Future generation – None EF 0.16 0.14
MacLeod and Cropley (1995) 54 Undergraduate 19 Cross sectional Interpretation/beliefs (pos) Future generation – None EF 0.17 0.14
MacLeod and Salaminiou (2001) 44 Clinical 57 Cross sectional Interpretation/beliefs (pos) Personal-future – None EF 0.76 0.16
MacLeod, Pankhania, 61 Clinical (suicidal) 35 Cross sectional Interpretation/beliefs (pos) Personal-future – None EF 0.57 0.13
Lee and Mitchell (1997)
MacLeod, Pankhania, et al. (1997) 61 Clinical (suicidal) 35 Cross sectional Interpretation/beliefs (neg) Personal-future – None EF 0.26 0.13
MacLeod, Tata, et al. (1997)df 33 Clinical 40 Cross sectional Interpretation/beliefs (neg) Personal-future – None EF 0.08 0.18
MacLeod, Tata, et al. (1997)df

33 Clinical 40 Cross sectional Memory (neg) Autobiographical memory – None EF 0.16 0.18
McCabe and Gotlib (1995) 40 Clinical (women) – Cross sectional Attention DOAT (750 ms) ≥ 500 ms None UCF 0.40 0.16
McCabe and Gotlib (1995) 40 Clinical (women) – Cross sectional Attention DOAT (750 ms) ≥ 500 ms None UCF 0.49 0.16
McCabe and Toman (2000) 59 Undergraduate – Cross sectional Attention DOAT (3 durations) – None UCF 0.31 0.13
McCabe et al. (2000)d Trait words 40 Community (women) 33 Remitted Attention DOAT (750 ms) ≥ 500 ms None UCF − 0.04 0.16
McCabe et al. (2000)d State words 40 Community (women) 33 Remitted Attention DOAT (750 ms) ≥ 500 ms None UCF 0.07 0.16
McCabe et al. (2000)d Trait words 40 Community (women) 34 Remitted Attention DOAT (750 ms) ≥ 500 ms Mood UCF 0.07 0.16
McCabe et al. (2000)d State words 40 Community (women) 34 Remitted Attention DOAT (750 ms) ≥ 500 ms Mood UCF 0.00 0.16
McNeely et al. (2008)e 29 Clinical 37 Cross sectional Attention Emotional Stroop (400 ms) ≤ 400 ms None UCEF 0.00 0.20
Meites et al. (2008) 42 Community 27 Remitted Interpretation/beliefs IAT (depression) – None UEF 0.53 0.16
Meites et al. (2008) 42 Community 27 Remitted Interpretation/beliefs IAT (depression) – Mood UEF 0.23 0.16
Meites et al. (2008) 42 Community 27 Remitted Interpretation/beliefs IAT (hopelessness) – None UEF 0.20 0.16
Meites et al. (2008) 42 Community 27 Remitted Interpretation/beliefs IAT (hopelessness) – Mood UEF 0.20 0.16
Mogg et al. (1995)i 32 Community 37 Cross sectional Attention Dot Probe (14 ms) ≤ 400 ms None UGCF 0.14 0.19
Mogg et al. (1995)i 32 Community 37 Cross sectional Attention Dot Probe (1000 ms) ≥ 500 ms None UCF 0.47 0.19
Phillips (2009) 322 Undergraduate 31 Cross sectional Interpretation/beliefs SST – Mood & Cog Load EF 0.52 0.06
Phillips (2009) 171 Undergraduate 33 Prospective Interpretation/beliefs SST – Mood & Cog Load EF 0.44 0.08
Phillips (2009) 322 Undergraduate 31 Cross sectional Self-esteem NLPT – Mood UGCEF 0.10 0.06
Phillips (2009) 171 Undergraduate 33 Prospective Self-esteem NLPT – Mood UGCEF 0.16 0.08
Phillips (2009) 306 Undergraduate 31 Cross sectional Memory (neg) Word stems P/P Mood CE 0.17 0.06
Phillips (2009) 306 Undergraduate 31 Cross sectional Memory (pos) Word stems P/P Mood CE 0.10 0.06
Phillips (2009) 160 Undergraduate 33 Prospective Memory (neg) Word stems P/P Mood CE 0.19 0.08
Phillips (2009) 160 Undergraduate 33 Prospective Memory (pos) Word stems P/P Mood CE 0.11 0.08
Rinck and Becker (2005) 82 Clinical 22 Cross sectional Attention Visual search ≥ 500 ms None CEF 0.23 0.11
Rinck and Becker (2005) 82 Clinical 22 Cross sectional Memory (neg) Anagrams C/C None CEF 0.22 0.11
Rude et al. (2001)h 31 Community 34 Remitted Interpretation/beliefs SST – Mood EF 0.39 0.19
Rude et al. (2001) 41 Community 34 Remitted Memory Word intrusions – Mood UCE 0.33 0.16
Rude et al. (2002) 339 Undergraduate 18 Cross sectional Interpretation/beliefs SST – None EF 0.55 0.06
Rude et al. (2002) 339 Undergraduate 18 Cross sectional Interpretation/beliefs SST – Cog Load EF 0.51 0.06
Rude et al. (2002) 339 Undergraduate 18 Prospective Interpretation/beliefs SST – None EF 0.46 0.06
Rude et al. (2002) 339 Undergraduate 18 Prospective Interpretation/beliefs SST – Cog Load EF 0.48 0.06
Ruiz-Caballero and González (1994) 40 Undergraduate – Cross sectional Memory (neg) Word stems P/P None E 0.21 0.16
Experiment 1
Ruiz-Caballero and González (1994) 40 Undergraduate – Cross sectional Memory (pos) Word stems P/P None E 0.33 0.16
Experiment 1
Ruiz-Caballero and González (1994) 26 Undergraduate – Cross sectional Memory (neg) Word stems P/P None CE 0.43 0.21
Experiment 2 (incidental encoding)
Ruiz-Caballero and González (1994) 26 Undergraduate – Cross sectional Memory (pos) Word stems P/P None CE 0.25 0.21
Experiment 2 (incidental encoding)
Ruiz-Caballero and González (1994) 26 Undergraduate – Cross sectional Memory (neg) Word stems C/P None E 0.13 0.21
Experiment 2 (intentional encoding)
Ruiz-Caballero and González (1994) 26 Undergraduate – Cross sectional Memory (pos) Word stems C/P None E 0.33 0.21
Experiment 2 (intentional encoding)
Ruiz-Caballero and González (1997) 28 Undergraduate – Cross sectional Memory (neg) Word stems P/P None CE 0.39 0.20
Ruiz-Caballero and González (1997) 28 Undergraduate – Cross sectional Memory (pos) Word stems P/P None CE 0.23 0.20
Ruiz-Caballero and González (1997) 28 Undergraduate – Cross sectional Memory (neg) Word stems C/P None CE 0.43 0.20
Ruiz-Caballero and González (1997) 28 Undergraduate – Cross sectional Memory (pos) Word stems C/P None CE 0.34 0.20
Scott, Mogg and Bradley (2001) 42 Undergraduate 19 Cross sectional Memory (neg) Lexical decision P/P None UGCEF 0.04 0.16
Experiment 1 (repetition priming, 56 ms)
Scott et al. (2001) Experiment 1 42 Undergraduate 19 Cross sectional Memory (pos) Lexical decision P/P None UGCEF 0.10 0.16
(repetition priming, 56 ms)
Scott et al. (2001) Experiment 1 42 Undergraduate 19 Cross sectional Memory (neg) Lexical decision C/P None UGCEF 0.22 0.16
(semantic priming, 56 ms)
Scott et al. (2001) Experiment 1 42 Undergraduate 19 Cross sectional Memory (pos) Lexical decision C/P None UGCEF 0.05 0.16
Scott et al. (2001) Experiment 2 42 Undergraduate 21 Cross sectional Memory (neg) Lexical decision C/P None UGCEF 0.27 0.16
Scott et al. (2001) Experiment 2 42 Undergraduate 21 Cross sectional Memory (pos) Lexical decision C/P None UGCEF 0.11 0.16
Scott et al. (2001) Experiment 2 42 Undergraduate 21 Cross sectional Memory (neg) Lexical decision C/P None UGCE − 0.12 0.16

(semantic priming, 2 s)
Scott et al. (2001) Experiment 2 42 Undergraduate 21 Cross sectional Memory (pos) Lexical decision C/P None UGCE 0.23 0.16
(semantic priming, 2 s)
Segal et al. (1995) 102 Clinical 30 Cross sectional Self-esteem Modified Stroop – None UCEF 0.26 0.10
(unmasked, 2 s)
Shane and Peterson (2007) Study 2 66 Undergraduate 20 Cross sectional Attention Dot Probe – None UCF 0.40 0.13
(combined durations)
Sheppes, Meiran, Gilboa-Schechtman 63 Undergraduate – Cross sectional Self-esteem IAT (mental set operation) – None UEF 0.09 0.13
and Shahar (2008)
Sheppes et al. (2008)a 63 Undergraduate – Cross sectional Self-esteem IAT (mental set maintenance) – None UCEF 0.10 0.13
Siegle et al. (2002) 76 Undergraduate – Cross sectional Attention Lexical decision (150 ms) ≤400 ms None UGCEF 0.30 0.12
Siegle et al. (2002) 76 Undergraduate – Cross sectional Attention Valence Identification (150 ms) ≤400 ms None EF 0.29 0.12
⁎Smallwood (2004) 40 Undergraduate 24 Cross sectional Memory (neg) Word fragments – None CE 0.45 0.16
Smallwood (2004) 40 Undergraduate 24 Cross sectional Memory (pos) Word fragments – None CE 0.36 0.16
Tarsia, Power and 32 Clinical 41 Cross sectional Memory (neg) Word identification C/P None UCEF 0.05 0.19
Sanavio (2003)c
Tarsia et al. (2003)c 32 Clinical 41 Cross sectional Memory (pos) Word identification C/P None UCEF 0.35 0.19
Taylor and John (2004) 24 Clinical 43 Cross sectional Memory (neg) Word stems P/P None CE 0.30 0.22
Taylor and John (2004) 24 Clinical 43 Cross sectional Memory (pos) Word stems P/P None CE − 0.04 0.22
Van der Does (2005) 46 Undergraduate 26 Remitted Interpretation/beliefs SST – Mood EF − 0.10 0.15
No valence condition
Van der Does (2005) 46 Undergraduate 26 Remitted Interpretation/beliefs SST – Mood & Cog Load EF 0.24 0.15
Watkins and Moulds (2007) 19 Clinical 39 Remitted Interpretation/beliefs SST – None EF 0.31 0.25
Comparison 1
Watkins and Moulds (2007) 21 Clinical 41 Cross sectional Interpretation/beliefs SST – None EF 0.88 0.24
Comparison 2
Watkins and Moulds (2007) 21 Clinical 31 Remitted Interpretation/beliefs SST – Cog Load EF 0.55 0.24
Comparison 3
Watkins and Moulds (2007) 19 Clinical 37 Cross sectional Interpretation/beliefs SST – Cog Load EF 0.63 0.25
Comparison 4
Watkins et al. (1992)di 34 Clinical – Cross sectional Memory (neg) Word stems C/P None CE 0.06 0.18
Watkins et al. (1992)di 34 Clinical – Cross sectional Memory (pos) Word stems C/P None CE 0.04 0.18
Watkins et al. (1996) 26 Undergraduate 19 Cross sectional Memory (neg) Word association C/C None CF 0.41 0.21
Watkins et al. (1996) 26 Undergraduate 19 Cross sectional Memory (pos) Word association C/C None CF 0.34 0.21
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word stem P/P None CE 0.26 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word stem P/P None CE 0.10 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word stem C/P None CE 0.14 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word stem C/P None CE 0.10 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word identification P/P None UCEF −0.03 0.09
701
(continued on next page)
702
Table 1 (continued)
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word identification P/P None UCEF 0.26 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word identification C/P None UCEF − 0.19 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word identification C/P None UCEF 0.10 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word association P/C None CF 0.25 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word association P/C None CF − 0.30 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word association C/C None CF − 0.08 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word association C/C None CF 0.04 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word retrieval P/C None CF − 0.02 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word retrieval P/C None CF 0.02 0.09
Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (neg) Word retrieval C/C None CF 0.07 0.09

Watkins et al. (2000) 134 Undergraduate – Cross sectional Memory (pos) Word retrieval C/C None CF 0.39 0.09
Wenzlaff and Bates (1998)d 68 Undergraduate 20 Cross sectional Interpretation/beliefs SST – None EF 0.29 0.12
Wenzlaff and Bates (1998)d 68 Undergraduate 20 Cross sectional Interpretation/beliefs SST – Cog Load EF 0.49 0.12
Wenzlaff and Eisenberg (2001) 69 Undergraduate 20 Cross sectional Interpretation/beliefs Homophones – None CE 0.53 0.12
Wenzlaff and Eisenberg (2001) 69 Undergraduate 20 Cross sectional Interpretation/beliefs Homophones (time pressure) – None CEF 0.68 0.12
Wenzlaff and Eisenberg (2001) 64 Undergraduate 20 Remitted Interpretation/beliefs Homophones – None CE 0.16 0.13
Wenzlaff and Eisenberg (2001) 64 Undergraduate 20 Remitted Interpretation/beliefs Homophones (time pressure) – None CEF 0.59 0.13
Wenzlaff et al. (2001) 111 Undergraduate 21 Remitted Attention Imbedded word task ≥500 ms Cog Load EF 0.03 0.10
Wenzlaff et al. (2001) 111 Undergraduate 21 Cross sectional Attention Imbedded word task ≥500 ms Cog Load EF 0.16 0.10
Wenzlaff et al. (2001) 117 Undergraduate 21 Remitted Attention Imbedded word task ≥500 ms None EF 0.21 0.09
Wenzlaff et al. (2001) 117 Undergraduate 21 Cross sectional Attention Imbedded word task ≥500 ms None EF 0.21 0.09
Wenzlaff et al. (2002) 146 Undergraduate 21 Cross sectional Interpretation/beliefs Disambiguated events – None CEF 0.36 0.08
Wenzlaff et al. (2002) 91 Undergraduate 21 Remitted Interpretation/beliefs Disambiguated events – None CEF 0.28 0.11
Williams and Nulty (1986) 31 Community (worriers) 49 Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.52 0.19
Williams and Nulty (1986) 21 Community (worriers) 49 Remitted Attention Emotional Stroop ≥500 ms None UCEF 0.28 0.24
Yovel and Mineka (2004)g 122 Undergraduate – Cross sectional Attention Emotional Stroop ≥500 ms None UCEF 0.02 0.09
Yovel and Mineka (2005) 72 Undergraduate – Cross sectional Attention Emotional Stroop (subliminal) ≤400 ms None UCEF 0.14 0.12
Yovel and Mineka (2005) 72 Undergraduate – Cross sectional Attention Emotional Stroop (supraliminal) ≥500 ms None UCEF − 0.06 0.12
Notes. DOAT = Deployment of Attention Task, IAT = Implicit Association Test, EAST = Extrinsic Affective Simon Task, NAP = Negative Affective Priming, NLPT = Name Letter Preference Test, SDJT = Self-Descriptiveness Judgement Task, SST
= Scrambled Sentences Task, P/P = perceptual encoding and perceptual retrieval, P/C = perceptual encoding and conceptual retrieval, C/P = conceptual encoding and perceptual retrieval, C/C = conceptual encoding and conceptual retrieval,
U = Uncontrolled, G = Goal Independent, C = Unconscious, E = Efficient, F = Fast.
a
Effect size calculated by averaging positive and negative self-esteem indices.
b
Effect size based on comparison between depressed and dysphoric groups.
c
Effect size based on chi-square calculation.
d
Effect size based on frequency calculation.
e
Effect size of zero entered because a non-significant result was reported but no statistics were available.
f
Effect size based on comparison between negative and positive stimuli.
g
Effect size based on partial correlation.
h
Refers to formerly depressed group with N 4 previous episodes.
i
Stimuli included depression and anxiety/threat words.
fragments), other priming retrieval tasks (anagrams, word associa- Table 3

tion, word retrieval and word identification), Autobiographical Moderator analysis for aspect of cognition.
Memory Task, Personal Future Task, yes/no future events, Scrambled Cognition n r CI95% p Homogeneity
Sentences Task, homophones, and other interpretation tasks (disam- analysis
biguated stories and disambiguated events). Lower Upper Q df p
a
Attention 58 .20 .15 .26 b.001 38.48 57 .97
Two potential second order moderators were also coded: Interpretation/beliefsb 47 .37 .31 .42 b.001 58.64 46 .10
Memorya 72 .13 .09 .18 b.001 45.88 71 .99
Self-esteema 25 .15 .07 .24 b.001 28.80 24 .23
2.3.5. Priming threshold
Attention studies were categorised according to their use of short Notes. Qbetween(3) = 38.43, p b .001. Homogeneity analysis based on Fisher's r, r values
based on inverse transformation of Fisher's r. Categories with different superscripts
(≤400 ms) or long (≥500 ms) stimulus presentation duration.
differ significantly. When one effect size relating to the EAST was removed from the
analysis, the relationship between self-esteem and depression increased to r = .17,
2.3.6. Processing level p b .001.
Implicit memory priming studies were classified into four
categories according to the level of processing required during
convention, this effect size indicates a small to medium relationship
encoding and retrieval: perceptual encoding and retrieval, perceptual
between depression and negatively biased implicit self-referential
encoding and conceptual retrieval, conceptual encoding and percep-
cognition. An indication of the stability of this association is provided
tual retrieval, and conceptual encoding and retrieval.
by the fail-safe N statistic, which addresses the problem of
unpublished studies in “file drawers” (Rosenthal, 1979). Specifically,
2.4. Inter-coder reliability this statistic showed that an additional 117 studies with effect sizes of
zero would be required to reduce the overall effect size to r = .10.
Effect sizes were calculated and coded by two independent research- Moderator analyses were conducted to determine whether aspect
ers. Coder 1 calculated, coded and double-checked all articles and Coder 2 of cognition, cognitive reactivity and control, study design and sample
calculated and coded a random selection of 20% of the articles. Inter-coder type influenced the relationship between depression and implicit
consistency for the double-coded articles was high (N99%), which cognition. As shown in Table 3, the association varied significantly
indicated that the remaining articles were appropriately calculated. according to aspect of cognition. All facets of cognition significantly
predicted depression, which corresponds with cognitive theories of
2.5. Statistical analyses depression. Studies that assessed negative interpretive biases and
beliefs produced a significantly larger effect size (r = .37) than studies
More than one effect size could be calculated for most studies that assessed attention, memory or self-esteem.
because they used multiple measures or designs. To avoid problems Second order moderator analyses were conducted to assess the
associated with data dependencies, an average effect size for each of roles of priming threshold in attention studies and level of processing
these studies was entered into the overall analysis (N = 89). However, in memory studies. Stimulus presentation duration (≤400 ms versus
all effect sizes from all studies were entered into the moderator ≥500 ms) did not moderate the relationship between depression and
analyses (N = 202). Pearson's r was used in this meta-analysis. Effect negative attentional bias, Qbetween(1) = .002, p = .97. Contrary to
sizes were calculated according to the guidelines provided by Lipsey prevailing consensus, significant associations were observed in
and Wilson (2001). studies that assessed both early (n = 11, r = .19, p b .001) and late
Effect sizes for between-group differences were calculated from (n = 41, r = .19, p b .001) stage attentional processing.
means and standard deviations, F values, or t values. If these statistics As shown in Table 4, the relationship between implicit memory
were not available, alternative methods were used; including frequencies biases and depression was moderated to a near significant degree
and chi-square (see Table 1). Inverse variance weighting was applied to (p = .08) by the level of processing required by encoding and retrieval
effect sizes (w= 1/SE). Fisher's transformation of r (zr) was used in the strategies utilized by the studies. Supporting the prediction of
analyses and the r and CI values back-transformed from zr. One low- and transfer-appropriate processing, studies that used perceptual encod-
two high-scoring univariate outliers were observed and recoded to .01 ing and retrieval strategies (r = .15) or conceptual encoding and
below and above the nearest score on the distribution, respectively. retrieval strategies (r = .15) produced significantly larger effect sizes
Homogeneity analyses were conducted using the Q statistic (see Table 2). than studies that employed perceptual encoding and conceptual
retrieval strategies.
3. Results As predicted, cognitive reactivity and control moderated the
relationship between depression and implicit biases (see Table 5).
An initial omnibus analysis indicated that effect sizes were Studies that utilized a mood induction and a cognitive load produced
heterogeneous. Consequently we used a random effects model for
all analyses, which generates relatively conservative estimates (Lipsey
Table 4
& Wilson, 2001). The omnibus analysis revealed a significant overall Moderator analysis for level of processing across implicit memory priming studies.
weighted effect size of r = .23. According to Cohen’s (1988)
Processing level at n r CI95% p Homogeneity
encoding/retrieval analysis
Table 2 Lower Upper Q df p
Overall effect size and homogeneity analysis.
Perceptual/perceptualb 30 .15 . 09 .21 b.001 19.62 29 .90
Model r CI95% p Fail-safe Homogeneity Perceptual/conceptuala 4 −.01 −.14 .12 .84 9.39 3 .03
N analysis Conceptual/perceptualab 23 .08 .01 .16 .03 18.89 22 .65
Conceptual/conceptualb 9 .15 .06 .25 .002 10.95 8 .21
Lower Upper Q df p
Notes. Qbetween(3) = 6.63, p = .08. Homogeneity analysis based on Fisher's r, r values
Random effect .23 .19 .28 b.001 117 229.31 88 b.001
size model
differ significantly. Similar results emerged when effect sizes relating to the Lexical
Note. Homogeneity analysis based on Fisher's r, r values based on inverse Decision Task were removed from the analysis: P/P, r = .15; P/C, r = −.01; C/P, r = .07;
transformation of Fisher's r. C/C, r = .16; P/P and C/C N P/C, ps = .06.
Table 5 Table 7
Moderator analysis for cognitive reactivity and control. Moderator analysis for sample type.
Manipulation n r CI95% p Homogeneity Sample n r CI 95% p Homogeneity

analysis analysis
Lower Upper Q df p Lower Upper Q df p

a
None 164 .20 .17 .24 b.001 164.90 163 .44 Clinical 65 .17 .11 .23 b.001 65.81 64 .41
Mood induction 22 .18 .09 .27 b.001 13.92 21 .87 Undergraduate 122 .23 .19 .27 b.001 107.95 121 .80
Cognitive loadb 13 .33 .21 .44 b.001 15.82 12 .20 Community 14 .25 .12 .38 b.001 9.24 13 .76
Mood induction and 3 .46 .25 .67 b.001 1.41 2 .49
cognitive load
based on inverse transformation of Fisher's r.
differ significantly.
4.1. Theoretical implications
the largest average effect size (r = .46). The average effect size for Models of cognitive vulnerability to depression are based on the
studies that applied a cognitive load manipulation (r = .33) was premise that depression-vulnerable individuals possess relatively
significantly larger than the mean effect size for studies that did not stable negative self-referential implicit cognitions that remain latent
use a cognitive manipulation. until triggered by environmental stress (Beck, 1967; Beevers, 2005).
Table 6 presents the results of the study design moderator analysis. A When activated, these cognitions are posited to influence all aspects
non-significant homogeneity analysis indicated that average effect size of information processing (Beck, 2008; Bower, 1981; Ingram et al.,
did not differ significantly between designs. As predicted by cognitive 1998; Teasdale, 1988). Dual-process theories propose that depression
vulnerability and dual process models of depression, negative implicit occurs when activated implicit cognitions are not adequately
self-referential biases significantly predicted depression in cross- regulated by explicit processing (Beevers, 2005; Haeffel et al.,
sectional, remitted and prospective research designs. All design 2007). Accordingly, we predicted that implicit biases would be
categories exhibited small to medium sized mean effects, with observed across all study designs and facets of cognition, and that
prospective designs achieving the strongest relationship at r = .27. cognitive mood and load manipulations would moderate the
A dimensional view of depression was supported by the moderator relationship between implicit cognition and depression.
analysis for sample type. As shown in Table 7, the non-significant Supporting cognitive vulnerability models of depression, negative
homogeneity analysis indicated that average effect size did not differ implicit self-referential cognition significantly predicted depression in
between studies that used clinical, undergraduate and community studies that used cross-sectional, remitted and prospective research
samples. In all three sample types, significant relationships were designs. Prospective designs achieved the strongest relationship at
observed between negative implicit cognition and depression. r = .27. These results support the view that negative implicit
Measures used in more than one study were included in the cognitions are not merely symptoms of depression or temporary
measurement strategy moderator analysis (see Table 8). The consequences of the disorder, but also precede its onset. Further
relationship between negative implicit self-referential cognition and theoretical support was provided by the facet of cognition moderator
depression varied significantly according to the measurement analysis, which showed that biases in attention, memory, interpre-
strategy used. Most measures significantly predicted depression. tation/beliefs and self-esteem all significantly predicted depression.
The SDJT produced the strongest effect size (r = .59), which was The magnitude of this association differed significantly according to
significantly larger than the average effects for studies that employed
the NLPT, word completion measures, other priming retrieval
strategies, IAT, Stroop, dichotic listening, yes/no future, imbedded Table 8
word, and lexical decision tasks. The NLPT, Dichotic Listening Task, Moderator analysis for measurement strategy
and yes/no future task did not predict depression.
Measure n r CI95% p Homogeneity
analysis
4. Discussion Lower Upper Q df p
Other priminga 23 .07 .01 .14 .03 30.13 22 .12

Acknowledging cognitive models of depression, this meta-analysis DOATabc 8 .22 .08 .36 .002 8.42 7 .30
aimed to analyse the relationship between negative self-referential Dichotic listeningab 4 .15 −.02 .32 .09 4.85 3 .18
Probe tasksabc 6 .23 .08 .39 .004 6.82 5 .23
implicit cognition and depression. An overall correlation of .23 was
Stroopab 18 .12 .04 .21 .004 15.55 17 .56
observed, which indicated that implicit cognitive biases explained a Personal futureabc 10 .35 .23 .47 b.001 15.15 9 .09
significant 5.3% of the variance in depression in a pooled sample of Homophonesc 4 .57 .40 .73 b.001 8.66 3 .03
7032. Additionally, results of several moderator analyses may assist IATab 16 .15 .06 .23 b.001 16.09 15 .38
the further development of depression theory, research methods and Lexical Decisionab 17 .17 .07 .26 b.001 9.87 16 .87
NLPTa 6 .07 −.07 .19 .35 2.84 5 .72
treatment strategies.
Other interpretationabc 8 .22 .13 .31 b.001 6.96 7 .43
SDJTc 3 .59 .39 .79 b.001 1.44 2 .49
Table 6 SSTbc 17 .48 .40 .56 b.001 21.80 16 .15
Moderator analysis for study design. NAP/Sternbergabc 7 .36 .21 .51 b.001 1.91 6 .98
Imbedded wordab 4 .16 .01 .30 .03 1.05 3 .80
Study design n r CI95% p Homogeneity Word completionab 31 .17 .10 .23 b.001 20.54 30 .90
analysis Exogenous cuingabc 10 .23 .11 .35 b.001 5.11 9 .83
Yes/no futureab 4 .16 −.03 .36 .10 2.83 3 .42
Lower Upper Q df p
Notes. Qbetween(17) = 120.54, p b .001. Homogeneity analysis based on Fisher's r, r
Cross-sectional 163 .21 .18 .25 b.001 153.83 162 .66
values based on inverse transformation of Fisher's r. Categories with different
Remitted 31 .19 .11 .28 b.001 24.60 30 .74
superscripts differ significantly. DOAT = Deployment of Attention Task, IAT =
Prospective 8 .27 .14 .40 b.001 10.15 7 .18
Implicit Association Test, NAP/Sternberg = Negative affective priming & Sternberg
Notes. Qbetween(2) = 0.96, p = .62. Homogeneity analysis based on Fisher's r, r values task, NLPT = Name Letter Preference Test, SDJT = Self-Descriptiveness Judgement
based on inverse transformation of Fisher's r. Task, SST = Scrambled Sentences Task.
the aspect of cognition assessed. Studies that assessed negative The significantly stronger result for studies that applied a cognitive
interpretive biases and beliefs produced a significantly larger average load suggests that dysregulated top-down processing may influence
effect size than attentional biases, memory biases and self-esteem. the emergence of depressive implicit cognitions to a greater extent
Notably, a significant relationship was revealed between depres- than accentuated bottom-up processing. A recent fMRI study of
sion and low implicit self-esteem. This finding corresponds with responses to emotional stimuli supports this interpretation (Siegle
theoretical accounts of depression but contradicts recent associations et al., 2007). In that study, most depressed participants exhibited
observed between depression and high implicit self-esteem (De Raedt hyperactive amygdalar and hypoactive prefrontal activity but a subset
et al., 2006; Franck, De Raedt, & De Houwer, 2007; Gemar, Segal, exhibited only hypoactive prefrontal functioning. That is, not all
Sagrati, & Kennedy, 2001). Indeed, only three notable negative effect depressed participants exhibited accentuated schematic processing.
sizes (indicating high self-esteem) were observed in the 25 self- The current result is consistent with Haeffel et al.’s (2007) dual
esteem studies in this meta-analysis. The largest positive self-esteem process model which posits dysfunctional explicit processing as the
result was obtained in a study that used the EAST (De Raedt et al., primary determinant of depression. However, most studies that
2006). As previously noted, recent evidence suggests that the EAST applied cognitive load manipulations assessed interpretive biases and
effect is reduced or reversed in the presence of negative affective beliefs, which produced larger effect sizes than the other aspects of
states and therefore may lack validity when used to assess the cognition. Thus, the larger average effect size for studies that applied a
attitudes of depressed individuals (Vermeulen et al., 2007). When this cognitive load may reflect the type of cognition assessed.
effect size was removed from the analysis, the relationship between
depression and negatively-biased self-esteem increased to r = .17. 4.2. Methodological implications
Negative biases in implicit attention and memory also predicted
depression. A second order analysis indicated that the relationship Considerable variability in effect size was observed according to
between depression and attentional bias was not influenced by the measurement strategy used. Fifteen measures employed in the
stimulus presentation duration (≤400 ms versus ≥500 ms), with studies produced significant effect sizes; however, the Dichotic
significant biases observed in studies that assessed earlier and later Listening Task, NLPT, and yes/no future task did not. The latency-
stage attentional processes. This finding runs counter to prevailing based SDJT produced the strongest average effect size. This task
research consensus that depressive biases are confined to later stages measures individuals' automatic associations between self-concept
of attention. Another second order analysis showed that the and positive or negative attributes. As such, it directly assesses
association between implicit memory biases and depression was implicit self-esteem as defined by Koole et al. (2001) and Rudman
moderated (at p = .08) by the level of processing required by (2004). In contrast, the weakest effect size was produced by the most
encoding and retrieval strategies utilized during testing. In line with indirect measure of self-esteem included in this meta-analysis: the
Barry et al.’s (2004) transfer-appropriate processing perspective, the NLPT. In this task, participants do not directly assess their self-esteem.
largest effect sizes were associated with studies that used matching Instead, they directly self-assess attitudes toward letters and self-
levels of processing in their encoding and retrieval tasks (i.e., esteem estimates are based on researchers' interpretations of
perceptual/perceptual and conceptual/conceptual). This pattern did participants' attitudes toward letters (De Houwer & Moors, 2010).
not change when Lexical Decision Tasks were removed from the The current results suggest that direct implicit measures of self-
analysis (see Table 4). The opposing view that observation of implicit esteem may produce more reliable associations with depression than
memory biases in depression depends upon elaboration and concep- indirect measures.
tual processing was not well-supported (e.g., Watkins, 2002; Williams After the SDJT, three of the next four strongest effect sizes related to
et al., 1997; Wisco, 2009). measures of interpretation and beliefs: homophones, the SST, and
The moderator analysis for cognitive reactivity and control personal future task. Both the SST and the personal future task were
revealed that the association between depression and implicit included in this meta-analysis because they were considered to be
cognition was influenced by cognitive manipulations applied during implicit in the sense of efficient and fast. De Houwer and Moors (2007)
experimental tasks. All manipulation categories significantly pre- note that responses under time pressure are logically associated with
dicted depression. Studies that utilized a negative mood induction and other implicitness features such as uncontrolled. However, the SST and
a cognitive load produced the largest average effect size, which was personal future tasks may allow sufficient conscious awareness to
closely followed by studies that applied a cognitive load manipulation. produce an overlap with measures of explicit processing. As an index
Studies that used a cognitive load procedure generated a significantly of implicit cognition, some applications of the SST may be more
larger mean effect size than studies that did not use any manipulation. appropriate than others (e.g., inclusion of a neutral condition).
This finding corresponds with dual-process theories and neurophys- Studies with undergraduate samples are sometimes criticised as
iological evidence of disrupted top-down processing in depression being “analogue” investigations with little generalizability to clinical
(e.g., Beevers, 2005; Haeffel et al., 2007; Johnstone et al., 2007). samples. Contrary to this position, our analysis of sample types in this
However, studies that employed a negative mood induction did meta-analysis revealed similar relationships between negative implicit
not achieve a larger average effect size than studies that used no self-referential biases and depression in clinical, undergraduate and
manipulation. This finding contradicts the conclusion drawn by community samples. Surprisingly, clinical samples produced the
several reviewers that sad mood facilitates the emergence of negative smallest correlation, although not significantly so. Evidence of de-
cognitions amongst formerly depressed individuals (e.g., Scher et al., pressive biases in diverse samples supports a dimensional view of
2005). It is also incompatible with evidence indicating a relationship depression (Ruscio & Ruscio, 2000), and is in line with prevailing
between depressive cognitive biases and hyperactive limbic activity neurophysiological evidence which suggests that “dysphoria is associ-
(e.g., Siegle, Steinhauer, Thase, Stenger, & Carter, 2002). Several ated with activation of the amygdala and related limbic structures, with
studies have directly assessed the effect of sad mood inductions on a progressive reduction of the DLPFC that is associated with increasing
formerly depressed groups, five of which were included in this meta- syndromal severity” (Thase, 2009, p.208).
analysis. Three of these studies found increased biases following a
mood induction (Gemar et al., 2001; Ingram, Bernet, & McLaughlin, 4.3. Treatment implications
1994; Ingram & Ritter, 2000) and two studies did not (McCabe et al.,
2000; Meites, Deveney, Steele, Holmes, & Pizzagalli, 2008). Thus, the Current psychotherapies for depression focus on changing negative
current results suggest that latent negative implicit biases are not beliefs, interpersonal functioning, coping skills, and emotional engage-
reliably activated by sad mood. ment (for review, see Hollon, Thase, & Markowitz, 2002). The most
widely used intervention, Cognitive Therapy (CT), is based on the conditions could not be included because relevant statistics were not
premise that modifying explicit negative beliefs will break habitual available. Excluded studies appeared to comprise similar numbers of
cognitive cycles associated with depression (Beck et al., 1979). This significant and non-significant effects, which may minimise potential
general approach is supported by the current finding that negative bias resulting from their exclusion. Also, several categories within the
interpretation and self-beliefs were stronger predictors of depression moderator analyses contained very few effect sizes, which may
than negative biases in attention, memory or self-esteem. However, decrease the reliability of the results. Importantly, confounds may
two year relapse/recurrence rates following CT can be as high as 73% for have impacted the moderator analyses. Notably, effect sizes for
certain patient groups (Bockting et al., 2005; Tang, DeRubeis, Hollon, interpretive biases and self-beliefs were associated with studies that
Shelton, & Amsterdam, 2007). Results of this meta-analysis indicate used cognitive load manipulations. This may explain the higher
that negatively-biased implicit cognitions are associated with depres- average effect size obtained for the cognitive load category in the
sion and may represent vulnerability factors for its onset, relapse or reactivity and control analysis. Finally, the correlational nature of data
recurrence. Consequently, treatment efficacy may be improved by from cross-sectional and remitted studies included in this meta-
incorporating strategies that address implicit processes. analysis prevents conclusions from being drawn about causal
From a dual-process perspective, implicit processing could be associations between implicit cognition and depression.
targeted in several ways. Therapies could aim to change conscious
expectancies which would trigger corrective explicit processing in 4.5. Future directions
response to negative implicit output (Beevers, 2005). Evidence suggests
that the efficacy of CT is determined by how much it (indirectly) Following extensive work, De Houwer et al. (2007, 2009; Moors &
increases an individual's metacognitive awareness of their implicit De Houwer, 2006; Moors et al., 2010) recently developed criteria
responses; and that low levels of awareness predict susceptibility to which enables measures to be classified as implicit if they possess one
relapse (Teasdale et al., 2002). To this end, Mindfulness Based Cognitive or more specific features of automaticity. For this meta-analysis, we
Therapy (MBCT, Segal, Williams, & Teasdale, 2002) not only assists attempted to utilize these implicitness criteria but found insufficient
recovered depressed individuals to maintain positive conscious expec- empirical evidence to confidently classify measures. Classification of
tancies, but also aims to directly increase metacognitive awareness by implicit features of measures would facilitate further investigations
training individuals to monitor their implicit responses. When vulner- into the nature of implicit depressive cognitions. Specifically, type of
able individuals become consciously aware of implicit responses that implicitness could be examined as a moderator of the relationship
are incompatible with their explicit goals, that awareness should trigger between implicit biases and depression (De Houwer & Moors, 2010).
corrective explicit processing. For example, it would be possible to assess the relative predictive
Alternatively, strategies associated with longer-term success could power of unconscious versus fast processes involved in depressive
target patterns of activation determined by associative network implicit cognition across studies. In turn, this knowledge could inform
structures (Beevers, 2005). Repeatedly engaging in corrective explicit treatment strategies. Thus, further research is needed to assess the
processing may change biased implicit cognitions through a process of implicitness of measures used in depression research (see De Houwer
consolidation (McClelland, McNaughton, & O'Reilly, 1995). For et al., 2009).
example, consistent efforts to prevent memories from entering Cognitive theories of depression suggest that implicit cognitions
awareness have been shown to impair their subsequent deliberate associated with depression represent elements of a unified self-
recollection (Anderson & Green, 2001). Accordingly, Joormann et al. schematic construct (e.g., Beck, 1967; Beevers, 2005) and that
(2009) recently developed a procedure that successfully trained depression-related explicit cognitions comprise a separate system of
depressed individuals to forget negative material. Researchers have self-referent thinking (e.g., Abramson et al., 1989; Beck, 1967).
also used a dot-probe task to train individuals' attentional biases away However, inconsistent relationships observed across and between
from negative cues, which reduced negative emotional responses to a implicit and explicit cognitions (e.g., Phillips, 2009) place some doubt
subsequent stressful task (MacLeod, Rutherford, Campbell, Ebsworthy, over the viability of this implied two-factor structure. A formal factor
& Holker, 2002). New associations could also be created by exposing analytic study of several implicit and explicit depressive cognitions is
vulnerable individuals to repeated positive experiences (Beevers, needed to reveal how these variables covary. Given the multifarious
2005). For example, repeated exposure to new “success” experiences nature of implicitness, many and various points of overlap may exist
may begin to alter a “failure” oriented associative network. Given that between implicit and explicit cognitions. Consequently, the structure
associations develop slowly over time through repetition, longer-term of negatively-biased implicit and explicit cognitions may be best
therapies would be required to create new cognitive structures. examined using a person-level approach. For example, it may be
However, the greatest promise for permanent recovery would possible to identify vulnerability profiles based on patterns of implicit
involve reducing negative self-referential implicit biases using both and explicit cognitions and to investigate how each profile may be
affective and cognitive strategies to target implicit and explicit systems, uniquely associated with depression. Identification of high-risk
respectively (Beevers, 2005). Such an approach would involve relearn- profiles could potentially inform the development of more individ-
ing implicit associations that underlie schematic biases. For example, ually tailored treatment programs.
exposure and experiential therapies are hypothesized to take effect via Further research is also needed to investigate conditions under
emotional processing. Emotion-Focused Therapy (Greenberg & Wat- which implicit cognitive vulnerability takes effect. To date, only two
son, 2005) aims to generate new cognitive structures by focussing on studies have investigated cognitive reactivity in a dual process
emotional experiences and the meanings attributed to them. Similarly, context. Haeffel et al. (2007) found that, when assessed separately,
Exposure-Based Cognitive Therapy incorporates elements of mindful- both explicit and implicit self-worth interacted with life stress to
ness meditation, affective engagement, activation of negative self- predict depression five weeks later. But when both interaction terms
views, cognitive analysis and interpretation (Hayes, Beevers, Feldman, were entered simultaneously into a hierarchical regression, only
Laurenceau, & Perlman, 2005; Hayes et al., 2007). Both approaches have explicit self-worth interacted with stress to predict subsequent
reported successful therapeutic outcomes. depression. Conversely, Steinberg, Karpinski and Alloy (2007)
assessed implicit and explicit self-esteem separately, and found that
4.4. Limitations only implicit self-esteem moderated the effects of life stress on
subsequent depression for high risk individuals, and only life stress
Several limitations should be considered when interpreting the predicted depression for low risk participants. Steinberg et al.
results of this meta-analysis. A relatively large number of studies or classified participants into risk groups according to their levels of
self-reported dysfunctional beliefs and attributions. Future implicit *Broomfield, N. M., Davies, R., MacMahon, K., Ali, F., & Cross, S. M. (2007). Further
evidence of attention bias for negative information in late life depression.
cognition research may profit from classifying high risk groups International Journal of Geriatric Psychiatry, 22, 175−180.
according to alternative criteria (e.g., neurophysiological attributes Cohen, J. (1988). Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale,
or attentional bias); or by examining life stress in interaction with NJ: Erlbaum.
Conner, T., & Feldman Barrett, L. (2005). Implicit self-attitudes predict spontaneous
other implicit cognitive biases. affect in daily life. Emotion, 5, 476−488.
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(2003). Patterns of processing bias for emotional information across clinical
4.6. Conclusion disorders: A comparison of attention, memory, and prospective cognition in
children and adolescents with depression, generalized anxiety, and posttraumatic
stress disorder. Journal of Clinical Child and Adolescent Psychology, 32, 10−21.
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Journal of Affective Disorders, 34, 227−234.
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Philips, W., Hine, D., & Thorsteinsson, E. (2010) Implicit Cognition and Depression A Meta Analysis

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Clinical Psychology Review 30 (2010) 691–709

Contents lists available at ScienceDirect

Clinical Psychology Review

Implicit cognition and depression: A meta-analysis

2.4. Inter-coder reliability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703

1. Introduction remains uncorrected by explicit processing. In this conceptualization,

2.2.2. Samples and depressive status 2.3.1. Aspect of cognition

W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

W.J. Phillips et al. / Clinical Psychology Review 30 (2010) 691–709

fragments), other priming retrieval tasks (anagrams, word associa- Table 3

Manipulation n r CI95% p Homogeneity Sample n r CI 95% p Homogeneity

Lower Upper Q df p Lower Upper Q df p

4. Discussion Lower Upper Q df p

Other priminga 23 .07 .01 .14 .03 30.13 22 .12

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