Masked facial affect priming is associated with therapy response in clinical depression

  • U. Dannlowski
  • A. Kersting
  • U.–S. Donges
  • J. Lalee–Mentzel
  • V. Arolt
  • Th. Suslow


In the present study, automatic processing of facial affect in clinical depression was investigated in the course of an inpatient treatment program. Patients suffering from clinical depression (n = 20) and healthy controls (n = 21) completed the facial affective priming task developed by Murphy and Zajonc (1993) twice, about 7 weeks apart. Subjects were instructed to evaluate neutral Chinese ideographs primed by masked displays of sad, happy, and neutral facial affect, including a no–prime condition. In the course of treatment, patients recovered significantly. In acutely depressed patients, no priming based on emotional faces could be found compared to neutral faces at time 1. However, compared to the no–prime condition, negative evaluation shifts elicited by neutral and sad faces were found which were significantly correlated with symptom severity. Patients with persisting high levels of depression after therapy judged ideographs more negatively in all three facial prime conditions at time 1. We conclude that clinically depressed patients are characterized by automatic processing biases for facial affect. An enhanced sensitivity for sad facial expressions and a negatively biased automatic processing of neutral and happy facial affect appears to be associated with depression persistence.

Key words

affective priming emotion facial expression amygdala processing bias 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adolphs R (2002) Neural systems for recognizing emotion. Curr Opin Neurobiol 12:169–177PubMedCrossRefGoogle Scholar
  2. 2.
    Adolphs R (2004) Emotional Vision. Nat Neurosci 7:1167–1168PubMedCrossRefGoogle Scholar
  3. 3.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (DSM–IV). APA, WashingtonGoogle Scholar
  4. 4.
    Beck AT, Steer RA (1987) Beck Depression Inventory: manual. Psychological Corporation Harcourt Brace Jovanovich, San Antonio, TXGoogle Scholar
  5. 5.
    Beringer J (1999) Experimental Run Time System. Version 3. 28. User’s manual. BeriSoft, FrankfurtGoogle Scholar
  6. 6.
    Biringer E, Lundervold A, Stordal K, Mykletun A, Egeland J, Bottlender R, Lund A (2005) Executive function improvement upon remission of recurrent unipolar depression. Eur Arch Psychiatry Clin Neurosci 2005 Apr 1 (Epub ahead of print)Google Scholar
  7. 7.
    Blair RJR (2003) Facial expressions, their communicatory functions and neuro–cognitive substrates. Philos Trans R Soc Lond B Biol Sci 358:561–572PubMedCrossRefGoogle Scholar
  8. 8.
    Bouhuys AL, Geerts E, Gordijn MCM (1999) Depressed patients’ perceptions of facial emotions in depressed and remitted states are associated with relapse: a longitudinal study. J Nerv Ment Dis 187:595–602PubMedCrossRefGoogle Scholar
  9. 9.
    Davis M, Whalen PJ (2001) The amygdala: vigilance and emotion. Mol Psychiatry 6:13–34PubMedCrossRefGoogle Scholar
  10. 10.
    de Mello MF, de Jesus Mari J, Bacaltchuk J, Verdeli H, Neugebauer R (2005) A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci 255:75–82PubMedCrossRefGoogle Scholar
  11. 11.
    Esteves F, Öhman A (1993) Masking the face: recognition of emotional facial expressions as a function of the parameters of backward masking. Scand J Psychol 34:1–18PubMedGoogle Scholar
  12. 12.
    Fridlund AJ (1994) Human facial expression: An evolutionary view. Academic Press, San DiegoGoogle Scholar
  13. 13.
    Gaebel W, Wölwer W (2004) Facial expressivity in the course of schizophrenia and depression. Eur Arch Psychiatry Clin Neurosci 254:335–342PubMedCrossRefGoogle Scholar
  14. 14.
    Geerts E, Bouhuys N (1998) Multi–level prediction of short–term outcome of depression: non–verbal interpersonal processes, cognitions and personality traits. Psychiatry Res 79:59–72PubMedCrossRefGoogle Scholar
  15. 15.
    Glaser J (2003) Reverse priming: Implications for the (Un–)conditionality of automatic evaluation. In:Musch J, Klauer KC (eds) The psychology of evaluation: Affective processes in cognition and emotion. Lawrence Erlbaum, Mahwah, pp 87–108Google Scholar
  16. 16.
    Gotlib IH, Krasnoperova E, Yue DN, Joormann J (2004) Attentional biases for negative interpersonal stimuli in clinical depression. J Abnorm Psychol 113:127–135CrossRefGoogle Scholar
  17. 17.
    Gur RC, Erwin RJ, Gur RE, Zwil AS, Heimberg C, Kraemer HC (1992) Facial emotion discrimination: II. Behavioral findings in depression. Psychiatry Res 42:241–251PubMedCrossRefGoogle Scholar
  18. 18.
    Gur RC, Schroeder L, Turner T, McGrath C, Chan RM, Turetsky BI, Alsop D, Maldjian J, Gur RE (2002) Brain activation during facial emotion processing. Neuroimage 16:651–662PubMedCrossRefGoogle Scholar
  19. 19.
    Hale WW (1998) Judgment of facial expressions and depression persistence. Psychiatry Res 80:265–274PubMedCrossRefGoogle Scholar
  20. 20.
    Hautzinger M, Bailer M, Worall H, Keller F (1995) Beck–Depressions– Inventar (BDI). Testhandbuch. Hans Huber, BernGoogle Scholar
  21. 21.
    Haxby JV, Hoffman EA, Gobbini MI (2002) Human Neural Systems for Face Recognition and Social Communication. Biol Psychiatry 51:59–67PubMedCrossRefGoogle Scholar
  22. 22.
    Heigl–Evers A, Ott J (1996) Die psychoanalytisch–interaktionelle Methode. Psychotherapeut 41:77–83CrossRefGoogle Scholar
  23. 23.
    Koschack J, Höschel K, Irle E (2003) Differential impairments of facial affect priming in subjects with acute or partially remitted major depressive episodes. J Nerv Ment Dis 191:175–181PubMedCrossRefGoogle Scholar
  24. 24.
    Laux L, Glanzmann P, Schaffner P, Spielberger CD (1981) Das State–Trait–Angstinventar. Beltz, WeinheimGoogle Scholar
  25. 25.
    Lehrl S (1995) Mehrfachwahl–Wortschatz–Intelligenztest MWTB. Hogrefe, GöttingenGoogle Scholar
  26. 26.
    Leppänen JM, Milders M, Bell JS, Terriere E, Hietanen JK (2004) Depression biases the recognition of emotionally neutral faces. Psychiatry Res 128:123–133PubMedCrossRefGoogle Scholar
  27. 27.
    Mogg K, Millar N, Bradley BP (2000) Biases in eye movements to threatening facial expressions in Generalized Anxiety Disorder and Depressive Disorder. J Abnorm Psychol 109:695–704PubMedCrossRefGoogle Scholar
  28. 28.
    Morris JS, Öhman A, Dolan RJ (1999) A subcortical pathway to the right amygdala mediating "unseen" fear. Proc Natl Acad Sci USA 96:1680–1685PubMedCrossRefGoogle Scholar
  29. 29.
    Murphy ST, Zajonc RB (1993) Affect, Cognition, and Awareness: Affective Priming With Optimal and Suboptimal Stimulus Exposures. J Pers Soc Psychol 64:723–739PubMedCrossRefGoogle Scholar
  30. 30.
    Nomura M, Ohira H, Haneda K, Iidaka T, Sadato N, Okada T, Yonekura Y (2004) Functional association of the amygdala and ventral prefrontal cortex during cognitive evaluation of facial expressions primed by masked angry faces: an event–related fMRI study. Neuroimage 21:352–363PubMedCrossRefGoogle Scholar
  31. 31.
    Persad SM, Polivy J (1993) Differences between depressed and nondepressed individuals in the recognition of and response to facial emotional cues. J Abnorm Psychol 102:358–368PubMedCrossRefGoogle Scholar
  32. 32.
    Phillips ML, Drevets WC, Rauch SL, Lane R (2003a) Neurobiology of emotion perception I: The Neural Basis of Normal Emotion Perception. Biol Psychiatry 54:504–514CrossRefGoogle Scholar
  33. 33.
    Phillips ML, Drevets WC, Rauch SL, Lane R (2003b) Neurobiology of emotion perception II: Implications for Major Psychiatric Disorders. Biol Psychiatry 54:515–528CrossRefGoogle Scholar
  34. 34.
    Phillips ML, Williams LM, Heining M, Herba CM, Russel T, Andrew C, Bullmore ET, Brammer MJ, Williams SCR, Morgan M, Young AW, Gray JA (2004) Differential neural responses to overt and covert presentations of facial expressions of fear and disgust. Neuroimage 21:1484–1496PubMedCrossRefGoogle Scholar
  35. 35.
    Rotteveel M, de Groot P, Geutskens A, Phaf RH (2001) Stronger Suboptimal Than Optimal Affective Priming? Emotion 1:348–364PubMedCrossRefGoogle Scholar
  36. 36.
    Rubinow DR, Post RM (1992) Impaired recognition of affect in facial expression in depressed patients. Biol Psychiatry 31:947–953PubMedCrossRefGoogle Scholar
  37. 37.
    Sackheim HA (2001) The definition and meaning of treatmentresistant depression. J Clin Psychiatry 62(Suppl 16):1–17Google Scholar
  38. 38.
    Segrin C (2000) Social skills associated with depression. Clin Psychol Rev 20:379–403PubMedCrossRefGoogle Scholar
  39. 39.
    Sheline YI, Barch DM, Donnelly JM, Ollinger JM, Snyder AZ, Mintun MA (2001) Increased amygdala response to masked emotional faces in depressed subjects resolves with antidepressant treatment: An fMRI study. Biol Psychiatry 50:651–658PubMedCrossRefGoogle Scholar
  40. 40.
    Sloan DM, Bradley MM, Dimoulas E, Lang PJ (2002) Looking at facial expressions: Dysphoria and facial EMG. Biol Psychol 60:79–90PubMedCrossRefGoogle Scholar
  41. 41.
    Staats H, Rüger U (2000) Interaktionelle Psychotherapie. In: Reimer C, Rüger U (eds) Psychodynamische Psychotherapien. Lehrbuch der tiefenpsychologisch orientierten Psychotherapien. Springer, HeidelbergGoogle Scholar
  42. 42.
    Surguladze SA, Young AW, Senior C, Brebion G, Travis MJ, Phillips ML (2004) Recognition accuracy and response bias to happy and sad facial expressions in patients with major depression. Neuropsychology 18:212–218PubMedCrossRefGoogle Scholar
  43. 43.
    Suslow T, Dannlowski U (2005) Detection of facial emotion in depression. In: Clark AV (ed) Mood state and health. Nova Science Publishers, Hauppauge, pp 1–32Google Scholar
  44. 44.
    Suslow T, Roestel C, Arolt V (2003) Affective priming in schizophrenia with and without affective negative symptoms. Eur Arch Psychiatry Clin Neurosci 253:292–300PubMedCrossRefGoogle Scholar
  45. 45.
    Whalen PJ, Rauch SL, Etcoff NL, McInerney SC, Lee MB, Jenike MA (1998) Masked presentations of emotional facial expressions modulate amygdala activity without explicit knowledge. J Neurosci 18:411–418PubMedGoogle Scholar
  46. 46.
    Whalen PJ, Shin LM, Somerville LH, McLean AA, Kim H (2002) Functional neuroimaging studies of the amygdala in depression. Semin Clin Neuropsychiatry 7:234–242PubMedCrossRefGoogle Scholar
  47. 47.
    Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) SKID–I. Strukturiertes Klinisches Interview für DSM–IV. Hogrefe, GöttingenGoogle Scholar
  48. 48.
    Wong PS, Root JC (2003) Dynamic variations in affective priming. Conscious Cogn 12:147–168PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • U. Dannlowski
    • 1
  • A. Kersting
    • 1
  • U.–S. Donges
    • 1
  • J. Lalee–Mentzel
    • 1
  • V. Arolt
    • 1
  • Th. Suslow
    • 1
  1. 1.Department of Psychiatry, School of MedicineUniversity of MünsterMünsterGermany

Personalised recommendations