The Interactive Role of Emotion and Expected Efficacy and Reward in Improving Cognitive Control in Patients with Depression

Background: Difficulties in cognitive control over negative emotional stimuli are a key depression characteristic. The Expected Value of Control (EVC) provides a framework for understanding how cognitive control is allocated, focusing on the motivational factors of efficacy and reward. Efficacy is the likelihood that an effort will result in a specific result, while reward is the value assigned to that outcome. However, the impact of emotion on the estimation of EVC has not been explored. We investigated the interplay between emotion and motivation (EVC) in depression. Methods: We utilized a within-between-subject design. The subjects were healthy controls (n=31) and those with depression (n=36), who underwent a clinical diagnostic interview, completed the General Health Questionnaire-12, the Beck Depression Inventory-II, and participated in an incentivized Emotional Stroop Paradigm where participants received cues indicating different levels of efficacy (low vs. high) and reward (low vs. high) prior to the targeted stimuli. Results: Significant interactions were detected between a) group × emotional valence × efficacy and b) group × reward regarding accuracy rates on the Emotional Stroop Task. Follow-up analyses revealed that during high-efficacy trials, the Control group demonstrated significantly greater accuracy than the Depressed group for both positive and neutral stimuli. In low-efficacy trials, the Controls were also significantly more accurate than the Depressed group when responding to negative stimuli. Additionally, the Depressed group performed significantly worse compared to the Controls on high-reward trials, no significant difference was detected between the two groups on low-reward trials. Conclusion: The emotional valence of stimuli can influence the assessment of reward efficacy, and individuals with depression struggle to focus on reward cues. Further research is necessary to incorporate emotion into the EVC framework. Clinical trial number : not applicable.