Journal of Neural Transmission

, Volume 126, Issue 12, pp 1653–1665 | Cite as

Covariation bias in depression - a predictor of treatment response?

  • Saskia Stonawski
  • Julian Wiemer
  • Catherina Wurst
  • Jannika Reitz
  • Leif Hommers
  • Andreas Menke
  • Katharina Domschke
  • Miriam A. Schiele
  • Paul PauliEmail author
Psychiatry and Preclinical Psychiatric Studies - Original Article


Covariation bias, defined as an overestimation of the relationship between fear-relevant stimuli and aversive consequences, is a well-investigated cognitive bias in anxiety disorders. As patients with affective disorders also show biased information processing, the aim of the present study was to investigate whether depressed patients also display a covariation bias between negative stimuli and aversive consequences. Covariation estimates of 62 inpatients with a current severe depressive episode were assessed at admission (n = 31) or after 6 weeks of treatment (n = 31) and were compared in a between-group design with 31 age- and sex-matched healthy controls. All participants showed a covariation bias for the relationship between negative stimuli and aversive consequences. Moreover, covariation bias at admission was significantly associated with various clinician- and self-reported dimensional measures of treatment response assessed 6 weeks later (Global Assessment of Functioning, Clinical Global Impression Scale, and Beck Depression Inventory), i.e., patients with a stronger bias showed greater impairment after 6 weeks of treatment. Categorical analyses revealed that overall, treatment non-responders—but not responders—were characterized by a covariation bias. The naturalistic study design without standardized pharmacological and psychotherapeutic treatments is a central limitation. We conclude that the covariation bias may constitute a possible marker in the field of emotional information processing in the search for effective predictors of therapy outcome.


Covariation bias Affective disorders Severe depressive episode Treatment response 



This work was supported by a grant from the Interdisciplinary Center for Clinical Research (IZKF), University of Wuerzburg (N-258 to LH), and from the German Research Foundation DFG, SFB-TRR-58, projects B01 to PP and project B05, and DFG project 378414384 to JW.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed written consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental HealthUniversity Hospital of WürzburgWürzburgGermany
  2. 2.Department of Biological Psychology, Clinical Psychology and Psychotherapy, Center of Mental HealthUniversity of WürzburgWürzburgGermany
  3. 3.Interdisciplinary Center for Clinical ResearchUniversity Hospital of WürzburgWürzburgGermany
  4. 4.Comprehensive Hearth Failure Center (CHFC)University Hospital of WürzburgWürzburgGermany
  5. 5.Department of Psychiatry and Psychotherapy, Medical CenterUniversity of Freiburg, Faculty of MedicineFreiburgGermany

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