DEPRESSION AND ANXIETY 27 : 1135–1142 (2010)

Review
A META-ANALYSIS OF THE MAGNITUDE OF BIASED
ATTENTION IN DEPRESSION
Andrew D. Peckham, B.A., R. Kathryn McHugh, M.A., and Michael W. Otto, Ph.D.

In this quantitative review, we examined the magnitude of attentional biases to

negative stimuli in depression. Results from 29 empirical studies examining
emotional Stroop or dot probe results in depressed participants (clinical
depression, nonclinical dysphoria, and subjects undergoing depressive mood
induction) were examined. Studies using the emotional Stroop task yielded
marginally significant evidence of a difference between depressed and
nondepressed samples, whereas those using the dot probe task showed significant
differences between groups (d 5 0.52). We found no evidence for significant
moderation of these effects by age, sex, type of depressed sample, year of
publication, stimulus presentation duration, or type of stimuli (verbal or
nonverbal), although statistical power for these tests was limited. These results
support the existence of biased attention to negative information in depression.
Depression and Anxiety 27:1135–1142, 2010. r 2010 Wiley-Liss, Inc.

Key words: depression; attention; cognition; reaction time; Stroop test;

meta-analysis

Cognitive models of depression assert that biases in
the processing of emotional information contribute to
the onset and maintenance of the disorder.[1,2] Accord-
ing to these models, mood-congruent information
processing biases influence memory, interpretation,
and attention in individuals with emotional disorders.
Studies have provided empirical support for these
models relative to memory bias[3,4] and interpretation
bias;[4,5] however, studies of attentional bias in depres-
sion have been inconclusive. Specifically, some studies
have supported greater attentional allocation to nega-
tively valenced stimuli,[6,7] whereas others have found
no evidence of this effect.[8,9]
The lack of consistent evidence for biased attentional
processing in depression has led some researchers to
hypothesize that depression is characterized by memory
but not attention bias, whereas anxiety is character-
ized by attentional but not memory bias.[9–12] This
distinction is consistent with the hypothesis that depres-
sion serves to focus emotional processing on past failures
so that unsuccessful endeavors can be avoided, whereas
anxiety helps to protect an individual from current or
future threat.[13] In partial support of this hypothesis,
evidence supports the presence of attentional bias toward
threat in anxiety disorders[14] and explicit memory bias
for negative information in depression.[3,15] However, the
presence of memory bias in anxiety[16] and attentional
bias in depression remain unclear.
In addition, theories of separate biases in anxiety and
depression do not adequately account for the finding
that attentional and memory biases are not reliably
present when depression and anxiety co-occur. Some
researchers have speculated that depressive symptoms
prevent the manifestation of (anxiety-based) attentional
biases when the disorders occur together,[8,17] but other
research has shown that attentional biases can still be
observed in comorbid samples.[18] Despite the pattern
of mixed results in studies of attentional bias in
Department of Psychology, Boston University, Boston,
Massachusetts
Correspondence to: Andrew D. Peckham, Massachusetts
General Hospital, 50 Staniford Street, Suite 580, Boston, MA
02114. E-mail: adpeckham@partners.org
The author discloses the following financial relationship within the past
3 years: Michael Otto is a consultant for Organon.
Received for publication 18 May 2010; Revised 3 August 2010;
Accepted 12 September 2010
DOI 10.1002/da.20755
Published online 3 November 2010 in Wiley Online Library
(wileyonlinelibrary.com).

r 2010 Wiley-Liss, Inc.

1136 Peckham et al.
depression, a quantitative review of this subject has not
yet been completed.
Several qualitative reviews have summarized research
on attentional bias in depression. Mogg and Bradley[18]
concluded that there is little evidence for subliminal
attentional bias in depression, and that an attentional
bias in depression is typically only found when the
material is self-referent and is presented for long
(Z1,000 ms) durations. Similarly, Mathews and
MacLeod[4] reported that there is evidence for biased
attention in depression, but only when the information
is mood-congruent and presented for a duration of
1,000 msec or more. Although these reviews describe
the mixed results found in studies of attentional bias,
an effect size analysis estimating the magnitude of
attentional bias across studies is lacking. This study
aims to address this need by conducting a meta-
analytic review of the studies of attentional bias in
depression.
MODERATING VARIABLES
Several moderating variables may account for these
mixed results. For example, the length of stimulus
presentation time varies widely across studies[6] with
presentation times ranging from 14 msec to over
1,500 msec. Studies using depressed samples have
yielded more reliable results for attentional bias when
stimuli are displayed for durations of 1,000 msec or
more; attentional bias has rarely been found at
subliminal durations.[19] It has been hypothesized that
bias is found at longer stimulus durations in depression
because this extended time period allows for strategic,
conscious processing of emotional information, while
shorter presentations are too brief to allow for this type
of elaborative processing.[12]
Variability in the emotional valence and type of
stimulus presented may also affect the degree to which
attentional bias is observed. For example, early research
indicated that biases in depressive individuals might
depend on emotionally congruent information (such as
sadness-related stimuli) rather than any type of globally
negative information (i.e. stimuli related to poverty or
war). Threatening stimuli that are often associated with
attention bias in anxiety have generally not been
associated with biased attention in depression.[20]
Negative information that is specifically self-referential
may be most likely to produce attentional biases in
depression.[19,21] Also, researchers have hypothesized
that using emotional faces instead of words may be a
better indicator of attentional bias, because faces are
both more salient and more strongly related to social
interaction than words.[22,23]
EXPERIMENTAL PARADIGMS FOR
ASSESSING ATTENTIONAL BIAS
Studies of attentional bias have used several measures
of attentional allocation to emotionally valenced
stimuli to quantify the degree of bias toward a
Depression and Anxiety
particular type of information. The two most common
methods—the emotional Stroop task and the dot probe
task—use reaction time data to assess attentional bias.
The emotional Stroop task is a version of the Stroop
task that requires participants to report the color of an
emotionally valenced word. The emotional Stroop
effect is observed when participants with emotional
disorders are delayed in their color-naming response to
emotional stimuli relative to neutral stimuli. In this
task, attentional bias scores are quantified as the
difference in reaction time between emotional and
neutral words; relatively slower response to emotional
stimuli reflects greater attentional bias toward those
stimuli. In a review, Williams et al.[24] reported that the
emotional Stroop effect is present in a variety of
disorders, including depressive and anxiety disorders.
However, the emotional Stroop task has been criticized
by researchers who argue that it provides an ambiguous
measure of attention, that the observed effect may
reflect a type of response bias, or that the response
is simply the effect of state-dependent mood con-
gruence.[9,20] An additional limitation is that the
emotional Stroop task is that it allows only one
stimulus (one word) to be presented at a time.
In contrast, the dot probe task[9] allows for two
stimuli to be presented simultaneously. In this task, the
two stimuli are presented quickly on a computer
screen, and one word is replaced by a probe.
Participants respond by pressing a key to correspond
to the location of the probe. Attentional bias can then
be derived by subtracting the average reaction time
when the probe replaces negative words from the
average reaction time when the probe replaces neutral
words. Faster response times to emotional words a
hypothesized to reflect early attentional allocation to
those stimuli. By presenting an emotional stimulus
simultaneously with a neutral stimulus, relative atten-
tional allocation can be measured more directly than on
the emotional Stroop task.
There are several other paradigms that measure
attentional bias, although their use has not been as
widespread as the dot probe or emotional Stroop tasks.
However, these additional paradigms have not yet
emerged as reliable indicators of biased attention in
depression, as too few studies have been completed to
allow for reliable estimates. Hence, they are not
considered in the present meta-analysis.
In summary, it is clear from a review of the literature
that questions about the magnitude of attentional
bias in depression remain unanswered. Although
many researchers have isolated important factors
related to the magnitude of biased attention, the field
lacks a quantitative analysis of the degree to which
these factors influence cognitive bias. Hence, our
goal was to investigate the overall magnitude of
biased attention in depression as compared to
nondepressed controls, along with careful considera-
tion of the potential moderating factors mentioned
above.
 Review: Attentional Bias in Depression
METHOD
SEARCH STRATEGY
A comprehensive literature search was conducted in order to
identify all published, peer-reviewed articles examining attentional
bias in depressive disorders. The databases PsycInfo, PubMed,
PsycArticles, and the Psychology and Behavioral Sciences Collection were
searched for articles containing the following keywords: attention,
bias, attention bias, cognitive bias, dot probe, Stroop, emotional Stroop,
depression, dysphoria, negative information, and mood disorder. Studies
were limited to those published in English that used human
participants, up to August 2010. After this initial search, the tables
and reference sections of these articles and qualitative reviews[3,19]
were examined for additional articles not revealed in the original
search.
STUDY SELECTION
After searching the literature, studies that met the following criteria
were included: (a) participants in the study were adults (18 years of age
and older), (b) the study included participants who were depressed,
including participants who had a current diagnosis of major depressive
disorder or dysthymic disorder, self-reported high levels of dysphoria
on a self-report questionnaire (e.g., the Beck Depression Inven-
tory[25]), or participants who underwent a negative mood induction
procedure, (c) the study included a control group of participants who
did not have depressive symptoms, including nonpsychiatric controls,
participants who reported low scores on self-report measures of
depression, or participants who underwent a neutral mood induction
procedure, (d) the study used either the emotional Stroop task or the
dot probe paradigm to measure attentional bias, (e) the emotional
stimuli used in the studies included both negatively valenced stimuli
(defined as general negative words or pictures, depression-related
words, sad faces, and threatening words) and neutral stimuli, (f) the
study reported quantitative data summarizing attentional bias that
could be transformed into an effect size.
Based on these methods, 52 studies were identified. Seventeen
studies of attentional bias in depression were excluded because they
used a method other than the emotional Stroop or dot probe task for
assessing attentional bias. Additionally, 13 dot probe or Stroop task
studies were excluded because their methods did not meet all
inclusion criteria described above, or because they did not provide
enough information to calculate bias scores. For any relevant study
that did not provide this required information, we attempted to
contact the corresponding author. This process allowed for the
inclusion of several additional studies, but data on studies whose
authors did not reply to our request or for authors who replied but
did not have access to the required data could not be included. Based
on these criteria, a total of 22 studies (9 dot probe and 13 emotional
Stroop) were ultimately selected, and as some studies included more
than one experiment, a total of 12 dot probe and 16 emotional Stroop
task studies were included in the analysis. This included 2,351
participants, of which 1,459 completed the dot probe task, and 892
completed the emotional Stroop task.
STUDY CHARACTERISTICS AND DATA
ABSTRACTION
Relevant participant data were collected from each of these studies,
including participant age, gender, diagnosis, Beck Depression
Inventory score,[25] and Spielberger State-Trait Anxiety Index
score.[26] Measures of attentional bias were extracted for each of the
studies in the analysis by one of the authors (A. D. P.). These included
reaction times to respond to stimuli in the dot probe and emotional
Stroop tasks, as well as the type of stimulus used (pictures or words),
1137
the valence of the stimuli presented (e.g. negative, positive, and
threatening), and the length of stimulus presentation. When
available, bias scores for emotional and neutral information were
also collected from these studies, reflecting the mean reaction
time for emotional compared to neutral information. In studies
using the emotional Stroop task, bias scores for negative information
are calculated by subtracting the average time to name the color of
neutrally valenced words from the average time to name the color of
emotionally valenced words. In dot probe studies, bias scores are
calculated by subtracting the mean response time when the probes are
in the same location as emotional stimuli from the mean response
time when probes are in opposite positions to emotional stimuli.
When bias scores for emotional information were presented with
their respective standard deviations in the original studies, these data
were used to calculate between-groups effect sizes (nondepressed vs.
depressed) in the form of Cohen’s d. In the absence of this information,
effect sizes were calculated if the difference in bias scores between
groups were presented as a t or F statistic, or if an emotional Stroop
study provided mean reaction time and standard deviations for
emotional and neutral stimuli, so that the above formula could be
applied. Bias scores represent the average reaction time toward a
category of stimuli as compared to a neutral stimulus; if this score is
positive, a bias toward the valenced stimulus is inferred, and if this
score is negative, a bias away from this type of stimulus can be inferred.
DATA SYNTHESIS
The effect sizes presented represent the between-groups difference
of attention bias toward emotional information. All bias scores were
calculated (or transformed, when necessary) such that if this effect
size is positive, it represents the depressed group showing greater bias
toward an emotional stimulus than the control group. If this score is
negative, it shows that the depressed group is showing a lesser bias
toward emotional information relative to the control group.
Effect sizes for attention bias were calculated for both the
emotional Stroop task and dot probe task studies. According to
Cohen’s standards,[27] effect sizes (d) of 0.2 are considered small, 0.5
are considered medium, and 0.8 are considered large. Moderator
analyses were then conducted to determine whether attention bias
varied as a function of depression severity, trait anxiety, participant
age, length of stimulus presentation, and type of stimulus presented.
In order to evaluate for publication bias, we calculated the ‘‘failsafe
N’’[28,29] separately for emotional Stroop studies and dot probe
studies. This method is hypothesized to generate the number of null
results needed to render the effect size nonsignificant, and is
calculated by multiplying the number of studies being analyzed by
5 and then adding 10 to this number.[29] Additionally, we constructed
a funnel plot based on mean effect size, and evaluated year of
publication as a standard moderator to further evaluate the possibility
of publication bias. These analyses were completed using the
Comprehensive Meta-Analysis software program.[30]
RESULTS
Table 1 shows the between-groups effect size for bias toward
negative stimuli for all studies included in the analysis, separated into
dot probe (Table 1) and emotional Stroop studies (Table 2). Results of
this analysis revealed a small but significant effect size, with depressed
participants showing greater attentional bias toward negative
information relative to nondepressed participants (d 5 0.37, k 5 29,
Po.001, 95% CI 5 .24, .50). Additionally, depressed participant
exhibited significantly less attentional bias toward positive informa-
tion (d 5 0.23, k 5 13, Po.01, 95% CI 5 .38, .08).
However, there was a significant difference in the magnitude of
attentional bias between the dot probe and emotional Stroop tasks
Depression and Anxiety
1138 Peckham et al.

TABLE 1. Dot probe between-groups effect size analysis

Cohen’s d, Cohen’s d, Cohen’s d, Cohen’s d, Cohen’s d,
Negative Negative Subliminal Cohen’s d, Socially Physically
stimuli, stimuli, negative Positive threatening threatening
Study Participants Stimulus 1,000 msec 500 msec stimuli stimuli stimuli stimuli

Mogg et al.[8] Patients Words 1.049

Mogg et al.[20] Patients Faces 0.374 0.283 0.133
Musa et al.[53] Patients Words 0.07 0.194
Gotlib et al.[45] Patients Faces 0.374 0.326 0.011
Gotlib et al.[22] Patients Faces 0.77
Joorman and Gotlib[48] Patients Faces 1.129
Joorman and Gotlib[48] Remitted Patients Faces 1.237
Average for patients 0.7 N/A N/A 0.02 0.06 N/A

Bradley et al.[40]
Nonpatients with negative Words 0.607 0.887 0.091
Experiment 1 mood induction
Bradley et al.[40] Nonpatients with Words 0.31 0.449 0.678
Experiment 2 self-reported depression
Bradley et al.[23] Nonpatients with Faces 0.539
Experiment 1 self-reported depression
Bradley et al.[23] Nonpatients with Faces 0.969
Experiment 2 self-reported depression
Bradley et al.[41] Nonpatients with Faces 0.244 0.028
self-reported depression
Chepnik et al.[42] Nonpatients with Words 0.303
negative mood induction
Shane and Peterson[54] Nonpatients with Pictures 0.39 0.421
Experiment 1 self-reported depression
Shane and Peterson[54] Nonpatients with Words 0.493 0.759
Experiment 2 self-reported depression
Average for nonpatients 0.39 0.5 0.38 0.59
Indicates effect size significance, Po.05.

(t(26) 5 2.5, Po.05). Effect size analysis of the dot probe and emotional
Stroop studies are presented in Figures 1 and 2 respectively. Studies using
the emotional Stroop task (k 5 16, n 5 863) produced marginally
significant evidence of a small between-groups difference in attentional
bias toward negative information (d 5 0.17, P 5.06, 95% CI 5 .07, .34).
In contrast, studies using the dot probe task (k 5 12, n 5 937) yielded a
significant and moderate between-groups difference in attentional bias,
with depressed groups showing significantly greater relative bias toward
negative stimuli (d 5 0.52, Po.001, 95% CI 5 .30, .74).
Several additional potential moderators were also evaluated. For these
analyses, type of task was included as a covariate; hence, the predictive
significance was examined accounting for differences attributable to the
type of task (Stroop or dot probe). Under these conditions, the average
participant age, proportion of women in the sample, duration of stimulus
presentation, and year of publication of the study offered no predictive
significance for effect size values (all P values4.18).
Dot probe studies were categorized as using either verbal
(emotional words, n 5 5) or nonverbal (emotional faces or pictures,
n 5 9) stimuli (all Stroop studies used verbal stimuli). No difference
was found in the magnitude of effect size for verbal and nonverbal
stimuli (t(12) 5 .89, P 5.26). Likewise, comparison of dot probe
studies using greater than 1,000 msec stimuli presentations (n 5 9,
d 5 0.59) relative to those that used 500 msec presentations (n 5 7,
d 5 0.54) revealed no significant differences (t(12) 5 .21, P 5.85).
Although all of the studies in the main analysis used depressive
stimuli (categorized in the literature as depressive, negative, or sad),
several other samples also included socially threatening or physically
threatening stimuli. There were no significant group differences in
attentional bias toward physically threatening stimuli (d 5 0.02, n 5 3,
P 5.89, CI 5 .22, .23); however, there was a trend toward greater
attentional bias among depressed participants toward socially
threatening stimuli (d 5 0.15, n 5 8, P 5.10, CI 5 .03, .33).
The influences of clinical status variables on between-groups
differences in attentional bias were also investigated separately for
Stroop and dot-probe studies. Stroop studies included patient (n 5 8),
remitted patient (n 5 3), and nonpatient (both nonclinical subjects with
an induced negative mood and subjects who self-reported high levels of
subclinical depressive symptoms; n 5 6) samples; no significant
differences in effect sizes (P values4.32) were found between these
two depressed groups. In dot probe studies, the effect tended to be
larger among patients (n 5 6, d 5 0.70) relative to nonpatients (n 5 8,
d 5 0.47); however, again this effect was not significant (P 5.38).
Analysis of the influence of anxiety on effect sizes was limited by
several factors. First, only two studies reported whether participants
were screened for the presence of anxiety disorders and whether those
with anxiety disorders were included. Second, several studies did not
report any measures of anxiety, and among those that did report
anxiety symptom severity, the measures used varied. The most
consistently used measure of anxiety—the STAI—was extracted from
four studies using the Stroop paradigm; however, these scores offered
no functional variability for analysis (i.e., mean STAI scores ranged
from 58.2 to 61.5). Greater variability was evident for the six studies
that reported STAI scores using the dot probe; analysis of this
relationship between mean anxiety scores and effect sizes indicated no
promising effects (r 5 .047).
PUBLICATION BIAS
As noted, year of publication of the study offered no predictive
significance of study effect sizes. Also, the funnel plot indicated a

Depression and Anxiety

 Review: Attentional Bias in Depression 1139

TABLE 2. Emotional stroop task between-groups effect size analysis

Cohen’s d, Cohen’s d, Cohen’s d,

Cohen’s d, Subliminal Cohen’s d, Socially Physically
Negative negative Positive threatening threatening
Study Participants stimuli: stimuli stimuli: stimuli stimuli
[44]
Gotlib and Cane Patients 0.136
Mogg et al.[8] Patients 0.054 0.012 0.045
Bradley et al.[17] Patients 0.357 0.000
Hedlund and Rude[47] Patients 0.125
Gotlib et al.[45] Patients 0.094 0.189 0.179 0.051
Kerr et al.[49] Patients 0.088 0.081
Lim and Kim[51] Patients 0.734 0.169 0.231 0.014
Broomfield et al.[35] Patients 0.024 0.016
Average for patients 0.16 0.06 0.01 0.02
[44]
Gotlib and Cane Remitted Patients 0.034
Hedlund and Rude[47] Remitted Patients 0.026
Merens et al.[52] Experiment 2 Remitted Patients 0.063 0.446
Average for remitted patients 0.02 0.45
Gotlib and McCann[46] Nonpatients with 0.293
Experiment 1 self-reported depression
Gotlib and McCann[46] Nonpatients with negative 0.044
Experiment 2 mood induction
Klieger and Cordner[50] Nonpatients with self-reported 0.56
mild depression
Klieger and Cordner[50] Nonpatients with self-reported 0.409
moderate depression
Hill and Knowles[31] Nonpatients with self-reported 0.005 0.371
depression
Gilboa-Schechtman et al.[43] Nonpatients with negative 0.245 0.028
mood induction
Average for nonpatients 0.24 0.17
Indicates effect size significance, Po.05.

Figure 1. Overall dot probe studies.

Figure 2. Overall emotional stroop studies.

Depression and Anxiety

1140 Peckham et al.
generally symmetrical spread of effect sizes. Finally, computation of
the failsafe N indicated that 70 null results of dot probe studies would
be required, respectively, to render the effect size nonsignificant for
the attentional bias differences between depressed and nondepressed
subjects.
DISCUSSION
Although the magnitude of biased attention in
depression has been a controversial topic, the com-
bined effect size across studies in our analysis supports
significantly greater attentional bias to negative in-
formation among depressed relative to nondepressed
participants. This effect size is moderate for the dot
probe task, according to Cohen’s (1988) standards and
smaller when assessed with the emotional Stroop task.
This presence of attentional bias in depression contra-
dicts Williams et al.[10,11] theory of cognitive biases, in
which depression is characterized by only biased
memory, and not biased attention; however, it is
consistent with the findings of several recent qualitative
reviews.[4,19]
Our meta-analysis suggests that the association
between depression and attentional bias is more robust
in the dot probe relative to the emotional Stroop task.
Although the relative merits of these measures are still
debated, the dot probe task was developed to serve as a
more direct measure of attentional bias than the
emotional Stroop task, a paradigm which has pre-
viously been considered a useful albeit imprecise
measure of biased attention. Effect sizes for attentional
bias on the emotional Stroop task were generally small,
representing little difference in reaction time to
negative or neutral stimuli in the depressed group, a
finding previously reported by Hill and Knowles.[31]
Researchers have argued that the ability of the dot
probe task to present a distinct, nonemotional stimulus
simultaneously with an emotional stimulus renders it
superior to emotional Stroop tasks.[32] The utilization
of newer measures of attentional bias has increased in
recent years and may lead to greater consensus on the
gold standard measurement of attentional bias. How-
ever, at this stage, we are confident that given the
benefits of the dot probe task,[6,20] the results indicated
in this study can be interpreted as reflecting a medium
effect size for the association between attentional bias
and depression. A significant, but smaller, effect was
found for a bias away from positive stimuli for the
depressed relative to the comparison samples.
Analysis of additional moderators of this effect
yielded no significant results. For example, our analysis
did not provide support for the hypothesis that
attentional bias in depression is optimally found at
longer stimulus durations; we found almost identical
effect size estimates for studies using greater than
1,000 msec stimuli presentations (n 5 9, d 5 0.59)
relative to those that used 500 msec presentations
(n 5 7, d 5 0.54).
Depression and Anxiety
We also found no significant differences in the
magnitude of attentional bias among the depressed
samples (patient, nonpatient, or remitted samples), an
effect that was found despite inconsistency in cut-off
scores for the identification of depressive symptoms in
nonclinical samples. Notably, the absence of a sig-
nificant difference in biased attention between clinical
and nonclinical levels of symptoms was also observed in
a meta-analysis of biased attention in anxiety.[14] As
such, one implication of our findings is that biased
attention to negative stimuli is a state characteristic of
negative affect (depressed or anxious mood) rather than
a marker of clinical depression. Therefore, biased
attention may be etiologically significant; consistent
with cognitive models of depression,[1,2] as depressed
mood emerges from life stressors or other sources,
attention becomes relatively biased toward negative
emotional stimuli, perhaps maintaining and deepening
emotional distress, depending on the degree of
subsequent exposure to such stimuli.
These findings did not appear to be accounted for by
the high comorbidity between depression and anxiety
disorders.[33] Consistent with expectation, the partici-
pants included in our analysis were characterized by
high levels of trait anxiety (although only two studies
included samples that met criteria for a comorbid
diagnosis of an anxiety disorder). Albeit limited by
small sample size, we did not find evidence that
comorbid anxiety explained the attentional bias found
in depressed samples. Also, our study results, docu-
menting reliable attentional biases on the dot probe
task for depressed samples, are fully inconsistent with the
notion that depression might inhibit the attentional
bias that characterizes anxiety.[14,17] Likewise, meta-
analytic review of the anxiety literature also indicates
that depression comorbidity does not influence atten-
tional biases in anxiety patients.[14] Accordingly, meta-
analyses of both the anxiety and depression literatures
support negative attentional biases in both disorders,
although anxiety samples demonstrate a much more
reliable bias for the Stroop task. Additional study of
larger sample of comorbid and single-diagnosis sam-
ples is needed to better clarify the interaction between
disorders, if any.
Finally, we found no significant evidence for an effect
of age on attentional bias—as suggested by recent
research (e.g.,[34])—although given the general lack of
research on cognitive bias in older populations,[35]
there was unfortunately little variability in the range of
average participant ages across studies.
We did not obtain evidence for a publication bias
over time: there was no significant association between
year of study publication and effect size; visual
inspection of our funnel plot analysis indicated a
generally symmetrical spread of effect sizes, and our
calculation of the ‘‘failsafe N’’ showed that 70 null
results of dot probe studies would be required to
render the effect sizes for these methodologies
nonsignificant.
 Review: Attentional Bias in Depression
LIMITATIONS
Several limitations must be considered when inter-
preting the results of our meta-analysis. Most notably,
our analysis examined the effect size of between-groups
differences in attentional bias. Although this analysis
allows for comparison of relative differences in biased
processing between depressed and nondepressed samples,
it does not specify the direction or the degree of bias from
zero.[36] For instance, a between-groups analysis may
show a large difference in attentional bias, but both
groups could potentially be demonstrating different
levels of bias away from negative information. There-
fore, an analysis of within-group attentional bias is
necessary to determine the degree of bias shown by
each individual sample. Many of the studies included in
our analysis did not provide enough information to
compare within-groups biased processing and thus
these effects were not calculated. In addition, the
interpretation of the magnitude of difference from zero
is more difficult given the lack of normative data for
such measures. Overall, the results of our analysis
demonstrate that depressed groups exhibit significantly
greater attentional bias toward negative information
relative to nondepressed groups, but the absolute
values of this bias (i.e., whether it they are greater
than 0) cannot be inferred.
The moderator analyses were limited by the small
number of studies that reported data on certain
variables, and by a low variance among these variables.
A number of complex moderating effects were reported
by Bar-Haim et al.[14] for a large (greater than 150)
number of studies of anxious samples. As such, more
complex moderating effects need to be investigated in
the depression literature once greater numbers of
studies are available. Our analysis is also limited by
the inability to fully separate symptoms of anxiety from
the depressed samples, although the evidence at hand
does not indicate that anxiety symptoms substantially
influence attentional biases in depression.
FUTURE DIRECTIONS
This finding indicating greater attentional bias
toward negative information among depressed indivi-
duals raises several important future directions. First,
given the significant difference in results between the
dot probe and emotional Stroop tasks, the continued
development and evaluation of measures of attentional
bias is of importance. Second, the presence of an
attentional bias toward negative information has
clinical implications. In recent years, interventions
specifically targeting information processing biases
have shown promise for the treatment of anxiety and
depression. For example, several studies in anxiety have
demonstrated efficacy for a training program designed
to reduce attentional bias toward threat and subsequent
anxiety symptoms.[37–39] MacLeod et al.[39] demon-
strated that a modified version of the dot probe task can
be used to train attentional bias toward a particular
1141
type of information. In their discussion of these
findings, the authors noted that attentional bias
training affected both anxiety- and depression-related
mood ratings to the same degree. Therefore, our
finding that depression is characterized by attentional
bias toward negative information on the dot probe task,
considered in relation to evidence from the bias
modification literature, supports the possibility that
attentional training for depression may be useful in
reducing bias to negative information. Recent support
for this potential can be found in the work of Baert
et al.[55] and Wells and Beevers,[56] who demonstrated
the utility of the dot probe in reducing depressive
symptoms.
The results of the present meta-analysis verify that
attentional bias is present in depression when measured
by the dot probe task, a finding that begins to resolve
the controversy surrounding attention bias in depres-
sion. As future research further expands upon our
knowledge of attentional bias in depression, clinical
interventions to target this process should be explored.
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