A primary goal of treatment using the cognitive perspective on psychological disorders is to

Major Depressive Disorder (MDD) is one of the most prevalent and debilitating forms of psychopathology (Kessler et al., 2005). Epidemiological surveys indicate that the lifetime prevalence of MDD is 16.6%, with estimates as high as 21.3% in women (Kessler, Berglund, et al., 2005; Kessler & Bromet, 2013); indeed, more than 30 million U.S. adults have met criteria for MDD in their lifetime (Haro et al., 2006). Importantly, MDD is a highly recurrent disorder; moreover, each depressive episode increases the likelihood that individuals will develop a subsequent episode of MDD (Solomon et al., 2000). Depression is also associated with enormous costs at both the individual and societal level; in fact, depression continues to be the leading cause of disability worldwide (World Health Organization, 2017), accounting for almost half of disability-adjusted life years (World Health Organization, 2012). Finally, in addition to documented adverse effects of depression on interpersonal relationships, educational attainment, and financial security (Kessler & Wang, 2009), MDD has been associated both concurrently and prospectively with poor physical health, cardiac problems, and cancer (Knol et al., 2006; Luppino et al., 2010).

Given the high prevalence and substantial burden of depression, it is not surprising that investigators have conducted a great deal of research with the goal of increasing our understanding of the onset, maintenance, and treatment of depressive episodes. In this review, we will examine how cognitive science, in particular, has promoted our understanding of depression. The current review advances our understanding of cognition and depression by including recent research that capitalizes on methodological developments (e.g., eye tracking technology) and techniques (cognitive bias modification paradigms), by offering a theoretical model (Fig. 1) that depicts the relations among cognitive factors and depression, and by discussing in detail the clinical implications of this work. We begin by providing an historical overview of cognitive theories of depression. We then review major advances in our understanding of cognition and depression, focusing specifically on cognitive deficits in executive functioning, working memory, and processing speed; cognitive biases in self-referential processing, attention, interpretation, and memory; deficits in cognitive control over stimuli or information that is congruent with one's emotional state (i.e., mood-congruent material); and the cognitive emotion regulation strategies of rumination, distraction, and reappraisal. Fig. 1 depicts the relations among cognitive factors that are most strongly supported by empirical evidence. Next, we discuss the implications of empirical findings for theory and practice. Finally, we offer our perspective on what we think lies ahead for researchers in this area. Certainly, researchers have studied other aspects of cognition, including goal selection, response selection, performance monitoring, and language; however, because these are relatively less studied in relation to depression, they are outside the scope of this review.

Historical overview of cognitive theories of depression

Researchers and clinicians have long acknowledged that cognition plays a critical role in the onset and maintenance of depressive disorders. Fifty years ago, Beck (1967) posited that biased acquisition and processing of information influence the etiology and course of depressive episodes. Beck argued that internal mental representations, or schemas, affect how depressed individuals perceive themselves and the world around them. He contended that individuals with depression have mood-congruent

Empirical findings

Over the past several decades a significant methodological shift has taken place in the measurement of cognition, and in particular, cognitive biases. The field moved away from an exclusive reliance on self-report measures of cognition toward emphasizing objective indices and experimental manipulations. This methodological shift reflects investigators' increased awareness of the drawbacks of self-report measures, which, for example, are limited by individuals' introspective ability and are

Implications for theory

Findings over the last several decades have largely supported the cognitive models of depression formulated by Beck, Bower, and Teasdale by providing evidence of the role of cognitive biases in the onset, maintenance, and recurrence of depressive episodes. Importantly, however, empirical findings have also served to expand and refine those early cognitive theories of depression in several important ways that are depicted in Fig. 1. For example, studies have highlighted the important role that

Clinical implications

At present, fewer than 40% of individuals who are treated for MDD achieve symptom remission with initial treatment (Gaynes et al., 2009; Holtzheimer & Mayberg, 2011). Given evidence that cognitive biases and emotion regulation strategies influence the onset, maintenance, and recurrence of depressive symptoms, cognition is an important target for intervention. Both theoretical models of depression and empirical findings suggest that ameliorating maladaptive cognition can reduce depressive

Future directions

Over the past several decades we have made exciting progress in our understanding of depression. What should we work towards and expect over the next several years? First and foremost, despite considerable progress in the measurement of cognition in depression, the psychometric properties of many information-processing tasks are still unknown or poor (Brown et al., 2014; Schmukle, 2005). It is critical that researchers use experimental methods and tasks with strong psychometric properties.

Take-home points

Over the last several decades, researchers have made major advances in elucidating factors involved in the onset and maintenance of depression, and have generated a number of important conclusions that have influenced the field; these findings are depicted in the model presented in Fig. 1. First, investigators have documented that depression is characterized by both general cognitive deficits (e.g., impairments in executive functioning and memory) and negative cognitive biases (i.e., the

Role of funding sources

Preparation of this paper was facilitated by Brain & Behavior Research Foundation Young Investigator Award 22337 to JL, SSHRC Grant 430-2017-00408 to JL, and NIMH Grants MH101495 and MH111978 to IHG.

Contributors

JL and IHG discussed the focus of the current review. JL wrote the first draft of the manuscript, and IHG contributed to and approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

Joelle LeMoult is currently an Assistant Professor in the Department of Psychology at the University of British Columbia. The overarching goal of her research is to further our understanding of the onset, maintenance, and recurrence of Major Depressive Disorder (MDD). Using a multimodal approach, she examines the cognitive, emotional, and biological responses to environmental stressors that contribute to symptoms of depression and comorbid anxiety disorders.

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