An Emoji-based Attention Bias Modification Intervention for Depressive Symptom Severity in Young Adults

Depression is a common mental health disorder and is a major cause of disability worldwide. Despite the wide range of treatments currently available, many individuals with depression do not acquire treatment for the disorder. Some patients are concerned about possible negative effects of antidepressants, although there is also a high rate of discontinuation among patients on antidepressant regimens. Relapse is a common occurrence, where at least 50% of the patients who recover from the first episode of depression will experience at least one more depressive episode. The consistent preference for psychological treatments over medication gives particular relevance to research aimed at developing suitable behavioral and psychological treatments for depression.

Digital mental health interventions could potentially improve access to mental health services and help overcome the stigma associated with seeking traditional mental health services. Vulnerable young people, especially individuals in rural or low-resource areas and marginalized communities face unequal access to mental health services. In contrast, there is an unprecedented surge in access to digital technology platforms and mobile devices among young adults worldwide. The mental healthcare access gap can be addressed by the opportunities provided by digital technology to provide better care for youth and young adults. The young adult demographic is a critical target group because it is the group with the highest incidence and prevalence of mood disorders. Many people often find it challenging to communicate about mental health issues, but if left unresolved, these issues can lead to deterioration of mental well-being.

A growing majority of young adults have access to mobile devices and the Internet. Meta-analyses of computerized and Internet-based treatments for depression found that they significantly reduced depressive symptoms compared to control groups. However, some methodological limitations were reported by the analyses, such as lack of follow-up testing, skewed post-intervention data, and lack of participant feedback. A review by Lamb et al. (2019) on the efficacy and practicality of remote psychotherapy for depression and anxiety disorders, reported that interventions that were administered over the telephone, through video-conferencing, or online were generally effective. Remote psychotherapy was reported to improve accessibility and convenience, especially for individuals living in rural and remote areas or individuals with limited mobility.

The dot-probe paradigm is a behavioral task widely employed to measure attention and perception biases. The task can be adapted in different ways to accommodate the investigation of various conditions such as generalized anxiety disorders, eating disorders, and substance use disorders. In the dot-probe task, two stimuli appear on a screen simultaneously in two separate spatial locations. One of the stimuli has an emotional valence, while the other is neutral. The stimuli then are removed, and a dot-probe appears in one of the locations where the stimuli were previously displayed. The subject's response times are recorded and a faster response to the probe when it appears in the previous location of a threatening stimulus is interpreted as vigilance for threat, indicating attentional bias.

Individuals suffering from emotional disorders exhibit negative attentional biases. Notably, this negative attention bias can also be present in non-depressed individuals with high risk of developing depression, as well as individuals who have recovered from episodes of depression. In general, studies on healthy adults show that the prefrontal cortex plays a role in response inhibition, specifically the right inferior frontal cortex region. When presented with competing stimuli, certain responses need to be inhibited in order to make a decision. In the case of attention biases, the lateral prefrontal cortex contributes by modulating responses to emotional information. Deficits in response inhibition result in a bias towards certain emotional information.