Abstract
Background
Difficulties in cognitive control over negative emotional stimuli are a key characteristic of depression. 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, using the EVC theoretical framework, 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, whereby 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 than 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 may have difficulties focusing on reward cues. Further research is necessary to incorporate emotion into the EVC framework.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-025-06847-8.
Keywords: Depression, Executive function, Expected value of control, Cognitive control, Emotion, Motivation, Reward, Efficacy
Introduction
Central features of depression are consistently associated with deficits in cognitive control [18]. Cognitive control encompasses many processes enabling flexible adjustments in behavior and cognition to align with present goals and is, therefore, essential for motivated, goal-oriented behavior [8]. Key aspects of cognitive control, including set shifting, updating working memory, and inhibition [24], are compromised in individuals with depression [21]. Such impairments are viewed as a diminished ability to exert cognitive control [18]. People with depression often find it difficult to let go of negative information and have trouble controlling irrelevant thoughts (inhibition), making it difficult for them to switch their focus from one task to another to achieve a goal, thereby, resulting in difficulties in emotion regulation and adapting to changing environments [16]. While deficits in cognitive control are central to understanding and treating depression [18], the field is limited by three main factors: a) there is an emphasis on descriptive models rather developing models that account for the underlying mechanisms, b) there is often a failure to integrate emotional, cognitive, and motivational impairments into a unified framework, and c) much of the research in this area has focused on Western samples. These limitations hinder current understandings as to why and how cognitive control is affected during depression [17, 18] and fails to consider depression as a global mental health concern.
There is a need for researchers to investigate the mechanisms underlying cognitive control impairments in depression. The Expected Value of Control (EVC) theoretical framework offers a normative mechanistic explanation regarding how motivation influences cognitive control allocation [31], and thus, may have utility in the context of depression. This integrative framework accounts for how cognitive control is used to monitor, specify, and regulate actions to achieve goals considering the rewards and costs [31]. Specifically, this framework outlines that the EVC for a given control signal in a certain condition is determined by components of efficacy (i.e., probability that a particular consequence will occur), value of an outcome based on the possible rewards or punishments (implicit or explicit) associated with the outcome, and the cost associated with the required mental effort for control allocation. The overall expectation resulting from estimation of efficacy, value and cost determines whether or not an individual should exert cognitive control [31, 32].
Grahek and colleagues [18] expanded on EVC theory to deepen mechanistic understandings of cognitive control impairments in depression. They claimed that goal-directed behavior is influenced by three key factors: outcome value (the anticipated reinforcement—either punishment or reward —linked to achieving an outcome), outcome controllability (the evaluation of a person’s ability to affect outcomes in their environment), and effort costs (the amount of effort needed to attain an objective, which comes with a cost) [18]. These motivational components are all influenced by prior learning experiences [11] and are impaired in individuals with depression [4, 18].
Within this framework, cognitive control deficits in depression are proposed to be related to impaired reward processing and shifts in how individuals perceive control in their environment [18]. The framework suggests that cognitive control deficits in depression can occur due to changes in motivational components. Specifically, in depression, efficacy and reward value are underestimated and effort cost is overestimated. This reduces the EVC, which in turn, decreases the allocation of cognitive control. Therefore, the cognitive control deficits observed in depression are proposed to be because of lowered expectations regarding exerting the control value, rather than a diminished capacity to exert that control [18]. This proposal has been confirmed in healthy, community samples [13] and depression in both simulation studies and with actual participants [18, 34].
Significant research has considered cognitive control in relation to negative emotional material in the context of depression. These investigations have revealed specific difficulties in not focusing on negative material, removing negative information from working memory, and inhibiting negative stimuli in those with depression [16, 18]. Importantly, some researchers have proposed that individuals with depression develop biases specifically in their cognitive control over emotional data, while not exhibiting widespread deficits in non-emotional cognitive control tasks, such as performance not being impaired on non-emotional Stroop Tasks [28]. Within this context, some studies have indicated that the amount of reward can enhance cognitive control over emotional material in healthy individuals [26, 27]. However, to date, this has not been investigated among individuals with clinical depression.
Additionally, the role of efficacy in improving cognitive control over emotional material has not yet been investigated among those with depression. Therefore, although the impact of negative emotional material on cognitive control has been well studied, the effect of negative materials in cognitive control tasks, such as emotional Stroop Tasks, on reward processing has not yet been investigated. Examining the influence of negative materials on reward processing can further examine the proposed framework and its utility in the context of depression [18].
Current study
In the current study we incorporated emotion into the EVC framework, within the context of depression. This integration is crucial because, although the effect of motivation on elucidating the mechanisms behind cognitive control impairments in depression has been examined, the impact of emotion on reward-processing and, subsequently, on cognitive control performance has not yet been investigated. Therefore, the aim of this study was to examine the effect of reward value and efficacy on cognitive control allocation over emotional stimulus in depression.
Moreover, in order to address a significant limitation of the field – the majority of research in this area has focused on individuals in Western high-income countries – in the current study we explored our aim among Iranian individuals with clinical depression. A recent systematic review found the prevalence of depression in Iran was moderate, growing, and concerning [33]. The authors highlighted the urgent need for research to inform effective measures and treatment targets to address depression among Iranian patients [33]. Further, while research has confirmed cognitive control deficits in Iranian patients with depression [1, 7], very little research has examined the mechanisms accounting for this deficit, such as exploring the interactive role of emotion and motivation, in cognitive control impairments.
While the aims were somewhat exploratory, given the novelty of the research, we did predict that high reward and efficacy conditions would improve performance in healthy individuals in positive, neutral and negative stimuli, but individuals with depression would perform worse for negative stimuli. We also predicted that the performance of those with depression would be improved on high efficacy and high reward values conditions when responding to positive and neutral stimuli, but not when responding to negative stimuli.
Materials and methods
Design and participants
We utilized a within-between-subject design. Ethical approval was received from the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1400.815) and all participants provided written informed consent. Prior to data gathering, a power analysis was performed using G*Power software, suggesting a sample size of N = 40 (20 per group) to achieve 95% test power to achieve an effect size of d = 0.30 at an α error of 0.05, using a mixed analysis of variance (ANOVA). Seventy-seven participants were included; however, 10 participants were excluded as they did not meet the inclusion criteria leaving a final sample size of 67 participants; Depressed Group (n = 36) and Control Group (n = 31).
The Depressed Group included those with Major Depressive Disorder (MDD) and were recruited from psychological and psychiatric clinics in Shiraz, Iran. To be included in the study, participants had to meet diagnostic criteria for a current Major Depressive Episode (MDE) within the last two weeks (following the DSM- 5 criteria, assessed using the SCID- 5-RV) and score > 14 on the Beck Depression Inventory-II (BDI-II; Beck et al., 1966). Inclusion criteria also included: being aged between 18 and 50, having no color blindness [20], having at least a primary school education to ensure reading and comprehension of the instructions, and not currently using antidepressants. The exclusion criteria were a) having a diagnosis of schizophrenia and/or other psychotic diseases, b) currenting abusing substances, and c) having a diagnosis of obsessive–compulsive disorder, bipolar disorder, and/or neurological conditions (e.g., epilepsy, tumors). The Depressed group had 36 participants (age M = 32.64 years, SD = 6.07; 2 men; 34 women).
The Control group included 31 individuals who were recruited from the general public using social media platforms. All participants in this group had a) no DSM- 5 disorder, as assessed on the SCID- 5-RV, b) not been previously given a psychiatric disorder, c) not been a patient in a psychiatric facility within the last six months (determined through a clinical interview), d) scored < 14 on the BDI-II, and e) were not using any medication to treat a psychiatric condition (age M = 30.68 years, SD = 6.84; 9 men and 22 women).
Measures
Structured clinical interview for DSM-V -research version (SCID- 5-RV)
MDD diagnosis was assessed using the SCID- 5-RV [12]. The SCID- 5-RV demonstrates strong psychometric features, including among Iranian samples [25]. According to Mohammadkhani et al. [25], the sensitivity index for MDD is 0.68, and the specificity is 0.75. In this study, a clinical psychologist administered the full SCID- 5-RV to diagnose MDD and to ensure that the healthy control participants had no psychiatric disorders.
Cognitive control task
The Emotional Word Stroop Task [35] measured cognitive control exertion over emotional words (negative, positive, and neutral). Initially, a total of 120 words were selected for the stimuli pool and these words were piloted using 10 healthy individuals and 10 individuals with depression1 (who were matched with the final sample in terms of age and gender; see Supplementary Table 1), who were asked to rank the words based on the valence (0 = completely unpleasant to 10 = completely pleasant). Based on the pilot, 22 negative words, 22 positive words, and 22 neutral words were selected for the Emotional Word Stroop task (see Appendix 1). Words were matched in length. Overall, each category of words was repeated three times across the main task. Participants were instructed to focus on the word’s ink color and to respond to color ink of the words as quickly and accurately as possible. Participants performed a practice block prior to commencing the experimental task to ensure participants were familiar with the positive, neutral or negative words and the task requirements. The experimenters did not explicitly tell the participants that they were about to see emotional material, as this request may artificially augment task performance [6].
We employed a previously used paradigm for reward cues [13], following ECV Theory [31]. Participants received rewards according to the reward cues presented, which included the reward amount (high and low = 150,000 and 20,000 Rials, respectively) and the efficacy level (high and low: rewards were completely based on a participant’s function and were not contingent on the participant’s function but were randomly assigned, respectively) for each trial. The trials (Fig.1) began with a fixation display lasting 1500 ms, and then a reward cue was presented for another 1500 ms. Next, the considered stimulus was shown for 1000 ms. When the participant responded, a blank screen appeared for 800 ms, and then feedback was displayed for 750 ms, indicating the reward they would receive in the next trial. The interval between the two attempts was set at 800 ms. To enhance the task’s difficulty, the response threshold for every trial was 750 ms, although reaction times (RTs) were noted for up to 1000 ms when the target stimulus appeared. The stimulus was provided at a screen center (12 inches) on a Microsoft Surface Pro 3 tablet, which was positioned 60 cm far from the participant.
Fig. 1.
Task design: In all trials, subjects are presented with an incentive cue, and then an emotional Stroop stimulus was presented (the target), and they received feedback on the amount of reward they earned. Four distinct cues are used to show whether a trial has high or low reward and efficacy levels [13]
Participants started by completing three practice blocks. In the initial block, which included 16 trials, we displayed a square stimulus in yellow (255, 237, 0), blue (0, 5, 255), red (255, 0, 0), and green (0, 128, 0). Participants familiarized themselves with the key-color mapping by putting pressure on the related keys on the keyboard (the F, D, K, and J keys were respectively assigned to green, blue, red, and yellow). The second practice block consisted of 20 trials, where participants associated cues with different levels of efficacy and reward. Ultimately, participants finished the third practice block, which comprised 32 trials and closely mirrored the actual task. The main task had a 198-trial block, which was counterbalanced between subjects. JAVA language was used to develop the experimental paradigm. Instructions for the incentive blocks are provided in Supplementary Material.
Procedure
The study took place in a single 90-min session. Initially, participants underwent a clinical interview using the SCID- 5-RV, followed by the Ishihara task [23] to evaluate color blindness. Those who met the eligibility criteria were assigned to either the healthy control group or the depressed group. Participants completed some questionnaires (BDI-II, and GHQ- 12, see Supplementary Methods) and then engaged in the cognitive control task. Finally, they were provided with the rewards they earned during the task.
Statistical analysis
Data analyses were performed by SPSS 27. The analyses assessed the average reaction time (RT) for correct responses (Accurate RTs) and the accuracy rate, calculated as the ratio of correct responses to total responses. A mixed repeated measures analysis of variance (ANOVA) with a 2 (Group: Depressed vs. Control) × 3 (Valence: positive, negative, neutral) × 2 (Efficacy: low vs. high) × 2 (Reward: low vs. high) design examined the impact of expected efficacy and reward on cognitive control allocation. In this analysis, Group served as a between-subjects factor, while Valence, Efficacy, and Reward were treated as within-subjects factors. The dependent variables included average accurate RTs and the accuracy rate. Univariate outliers were identified by determining mean RTs that exceeded three standard deviations, leading to the exclusion of 11 participants (the RT data showed normal distribution when these outliers were removed) from the ANOVA, which used average RTs as the dependent variable. This left 27 participants in the Depressed Group and 29 participants in the Control Group. Additionally, participants (n = 22) who performed poorly (i.e., achieving < 60% accuracy on high efficacy trials) were excluded from the ANOVA analyses that used accuracy rate as the dependent variable, resulting in 24 participants in the Depressed Group and 21 participants in the Control Group for these analyses (Fig. 2). Effect sizes were reported as partial eta (small: ηp2 = 0.01; medium: ηp2 = 0.06; and large: ηp2 = 0.14) and Cohen’s d (small: d = 0.20; medium: d = 0.50; and large: d= 0.80) [9].
Fig. 2.
CONSORT flow diagram depicting the progression of participants of current study
Results
Participant characteristics
Clinical and demographic data can be found in Table 1. The two groups showed no significant differences regarding education, age, marital status, or occupation. However, there was a significant difference in gender between the groups, with there being a greater proportion of women than men and this difference was more pronounced in the Depressed group. To account for this difference, we included gender as a covariate in the subsequent analyses, which revealed a similar trend of results.
Table 1.
Participant’s characteristics
| Variable | Depressed subjects (N = 36) |
Control subjects (N = 31) |
Statistical parameter | p |
|---|---|---|---|---|
| Age, Mean (SD) | 32.64 (6.07) | 30.68 (6.84) | t = 1.24 | .21 |
| Sex, No. (%) | ||||
| Male | 2 | 9 | χ 2 = 6.69 | .01* |
| Female | 34 | 22 | ||
| Education, No. (%) | ||||
| Diploma | 2 | 0 | χ 2 = 2.48 | .47 |
| Bachelor | 24 | 19 | ||
| Master | 8 | 9 | ||
| Ph.D | 2 | 3 | ||
| Marriage status, No. (%) | ||||
| Single | 22 | 16 | χ 2 = 1.06 | .58 |
| Married | 12 | 14 | ||
| Divorced | 2 | 1 | ||
| Occupation, No. (%) | ||||
| Employed | 24 | 24 | χ 2 = 0.948 | .33 |
| Unemployed | 12 | 7 | ||
| GHQ- 12, Mean (SD) | 23.19 (6.64) | 10.13 (4.52) | t = 9.50 | <.001** |
| BDI-II, Mean (SD) | 29.44 (11.22) | 5.39 (7.17) | t = 10.59 | <.001** |
BDI-II Beck’s depression inventory-version 2, GHQ- 12 general health questionnaire- 12 items, **P < 001
Cognitive control
Mean reaction time (RT)
The mixed repeated measures ANOVA regarding RT revealed a non-significant interaction effect. Additionally, the main effects of Group, F (1,54) = 0.01, p = 0.91, ηp2 < 0.001, Valence, F (2,108) = 0.48, p = 0.95, ηp2 =. 001, Reward, F (1,54) = 0.01, p = 0.93, ηp2 < 0.001, and Efficacy, F (1,54) = 0.76, p = 0.38, ηp2 = 0.01, were all not significant.
Accuracy rate
The mixed repeated measures ANOVA regarding accuracy rate indicated that the main effects of Group, F (1,42) = 2.12, p = 0.153, ηp2 = 0.05, Valence, F (2,84) = 0.60, p = 0.544, ηp2 = 0.01, Reward, F (1,42) = 1.14, p = 0.290, ηp2 = 0.03, and Efficacy, F (1,42) = 2.08, p = 0.156, ηp2 = 0.05, were all non-significant. Significant interaction effects of Group × Valence × Efficacy, F (2,84) = 3.59, p = 0.032, ηp2 = 0.08, and Group × Reward, F (1,42) = 11.86, p < 0.001, ηp2 = 0.22, were found. All other interactions were non-significant.
As shown in Table 2, follow-up analyses of the Valence × Efficacy × Group interaction revealed that the Control Group was significantly more accurate than the Depressed Group for positive and neutral words in high-efficacy trials. Additionally, for negative valanced words, in low efficacy trials the Control Group demonstrated significantly greater accuracy than the Depressed Group (see Fig. 3). Within the Depressed Group, participants showed significantly higher accuracy for neutral words in the low efficacy trials (M = 91.8%, SD = 6.13) compared to the high efficacy trials (M = 88.35%, SD = 7.27), t (23) = 2.44, p = 0.022, d = 0.50. No other follow-up interactions were found to be significant (Table 3).
Table 2.
Follow up analysis of interaction effects of valence × efficacy × group based on accuracy rate
| Variable | Group | Mean | SD | df | t (p- value) | Cohen’s d | |
|---|---|---|---|---|---|---|---|
| Positive words | Low Efficacy | Controls | 92.36 | 6.01 | 43 |
1.13 (.264) |
0.33 |
| Depressed | 90.25 | 6.41 | |||||
| High Efficacy | Controls | 93.48 | 6.97 | 43 |
2.90 (<.001) |
0.86 | |
| Depressed | 88.05 | 6.97 | |||||
| Negative words | Low Efficacy | Controls | 92.78 | 7.31 | 43 |
2.16 (.036) |
0.64 |
| Depressed | 87.78 | 8.09 | |||||
| High Efficacy | Controls | 91.21 | 6.33 | 43 |
0.79 (.429) |
0.23 | |
| Depressed | 89.47 | 8.04 | |||||
| Neutral words | Low Efficacy | Controls | 93.5 | 5.39 | 43 |
0.98 (.332) |
0.29 |
| Depressed | 91.8 | 6.13 | |||||
| High Efficacy | Controls | 92.48 | 5.39 | 43 |
2.13 (.038) |
0.63 | |
| Depressed | 88.35 | 7.27 | |||||
Fig. 3.
Interaction of group and efficacy for positive words (a), neutral words (b) and negative words (c). Note. Error bars represent 95% confidence of interval
Table 3.
Follow up analysis of interaction effects of group × valence × efficacy based on accuracy rate
| Group | Variables | Mean | SD | df | t (p- value) | Cohen’s d | ||
|---|---|---|---|---|---|---|---|---|
| Depressed group | Positive words | Low Efficacy | 90.25 | 6.41 | 23 |
1.87 (0.074) |
0.38 | |
| High Efficacy | 88.05 | 6.97 | ||||||
| Negative words | Low Efficacy | 87.78 | 8.09 | 23 |
1.52 (0.141) |
0.31 | ||
| High Efficacy | 89.47 | 8.04 | ||||||
| Neutral words | Low Efficacy | 91.8 | 6.13 | 23 |
2.44 (0.022)* |
0.50 | ||
| High Efficacy | 80.35 | 7.27 | ||||||
| Controls | Positive words | Low Efficacy | 92.36 | 6.01 | 20 |
0.94 (0.357) |
0.20 | |
| High Efficacy | 93.48 | 5.31 | ||||||
| Negative words | Low Efficacy | 92.78 | 7.31 | 20 |
1.05 (0.304) |
0.23 | ||
| High Efficacy | 91.21 | 6.33 | ||||||
| Neutral words | Low Efficacy | 93.50 | 5.39 | 20 |
0.64 (0.525) |
0.14 | ||
| High Efficacy | 92.48 | 5.39 | ||||||
*Significant at 0.05 level (p<0.05)
As shown in Fig. 4, follow-up analyses of the Group × Reward interaction indicated that the Depressed group (M = 89.97%, SD = 6.56) and Control group (M = 91.69%, SD = 5.57) had no significant difference in the low reward condition, t (43) = 0.94, p = 0.353, d = 0.28. However, in the high reward condition, the Depressed Group (M = 88.59%, SD = 5.61) was significantly less accurate than Controls (M = 93.58%, SD = 4.44), t (43) = 3.26, p < 0.001, d = 0.97. The Controls performed significantly better (more accurately) in the high reward trials (M = 93.58%, SD = 4.44) in comparison to the low reward trials (M = 91.69%, SD = 5.57), t (20) = 2.14, p = 0.045, d = 0.46. Conversely, participants in the Depressed Group showed significantly better performance in the low reward trials (M = 89.97%, SD = 6.56) than in the high reward trials (M = 88.59%, SD = 5.61), t (23) = 2.50, p = 0.020, d = 0.51.
Fig. 4.
Means of correct ratio for the depressed group and control group at low and high reward. note. error bars represent 95% confidence of interval
Discussion
This study explored how emotion and motivational factors (reward and efficacy) interact as a potential mechanism for cognitive control deficits when presented with emotionally valanced stimuli in individuals with depression. Our findings showed that, while no significant differences were detected in reaction times between the Control and Depressed Groups, notable differences were observed in response accuracy. We found that the interaction between Group, Efficacy and Valence was significant. Specifically, the Depressed Group had significantly less accurate performance than the Control Group on positive and neutral words, but not negative words, on high efficacy trials, with large effect sizes observed. The Depressed Group also had significantly less accurate performance than the Control Group in response to negative words on low efficacy trials, with a large effect size detected. It seems, therefore, that the Depressed group, when compared to the Control Group, still displayed cognitive control deficits for positive and neutral stimuli despite increasing efficacy. However, for negative stimuli the Depressed Group, while having poorer accuracy performance in the low efficacy condition, when efficacy was high the two groups did not differ significantly.
Comparing the present findings with our previous study [34], which used the classic non-emotional word-color Stroop Task, revealed that reward and efficacy can both jointly and separately improve cognitive control. However, the findings differed in the current study using the emotional Stroop Task. Specifically, the interaction effect of Group and Efficacy was significant in our previous study using the classic non-emotional Stroop Task [34]. The findings in this previous study suggested that efficacy had lower effects on the performance of individuals with depression when compared to healthy controls. However, in the present study, which used the emotional Stroop task, the interaction effect of group, efficacy and valence was significant. Thus, it seems that the emotional valence of stimuli may influence the evaluation of efficacy among those with depression.
The study also found that there were no significant differences in accuracy in low-reward trials between the Depressed Group and Control Group. However, in the high-reward trials, the Control Group performed significantly better than the Depressed group, with a large effect size found. Within-subject comparisons showed that while Controls performed significantly better in the high reward compared to low reward trials, the Depressed Group had significantly poorer performance in high reward trials than low reward trials. In other words, increasing the amount of reward in the Control Group led to improved performance, but in the Depressed Group, increasing the reward resulted in a decrease in performance. A possible explanation for these findings is that people with depression may have difficulty paying attention to rewarding cues. Reward processing may be disrupted in multiple ways. For instance, there is a distinction between anticipatory and consummatory reward. Consummatory reward relates more closely to “liking,” or the pleasure experienced in the moment upon delivery of reward, whereas anticipatory reward relates more closely to “wanting,” or to the pleasure one expects to experience from a future rewarding experience [29]. In a review on this topic, Rutherford et al. [29] concluded that anticipatory reward is reduced in MDD, whereas consummatory reward may remain intact in depression. In line with this, our findings revealed that expected reward cues (anticipatory) did not improve performance among those in the Depressed Group. Likewise, Anderson et al. [2] showed that reward sensitivities were lower in people with depression than in healthy controls. Auerbach et al. [3] also showed that the volume and activity of the accumbens nucleus, the brain area responsible for reward, was reduced in people with depression. Therefore, those with depression may be less sensitive to reward cues. These findings align with the EVC model [18], as they show decreased EVC in those with depression when compared to healthy controls. Therefore, individuals with depression may lack motivation in exerting cognitive control, which leads to difficulties in emotion regulation and cognitive biases [22].
The findings of the present study demonstrated a significant interaction effect of group and reward,whereas in our work using the classic non-emotional Stroop Task [34] the interaction effect of group and efficacy was significant. Therefore, we can infer that reward value may influence the cognitive control performance irrespective of emotion. This might be because receiving a reward itself can induce positive emotion. Conversely, a comparison of present results with the prior study [34] indicates that the assessment of efficacy may be influenced by emotion, suggesting that when an emotional stimulus is present, efficacy cannot be appraised independently of emotional factors. Another possible explanation is that due to the long duration of the experimental session, fatigue affected the performance of participants, especially those with depression. This may have resulted in participants paying attention only to completing the task. Since those with depression often experience fatigue earlier [10], it seems that fatigue may account for some of the findings in this study. Additionally, such results could be influenced by existing medical conditions and older age, as well as comorbidities with other forms of psychopathology, such as anxiety. Therefore, future research should compare various age groups and comorbidity to investigate the impacts of these factors.
Overall, our findings suggest that individuals with depression may have some difficulties in estimating reward and efficacy especially in presence of emotional stimuli. The results of this study indicate that the motivational component of EVC, especially efficacy, changes under the influence of emotion. According to the affective gradient hypothesi [30], emotion is the only form of value that drives action. Consequently, emotion can play a crucial role in estimating EVC and subsequently in motivating behavior. Therefore, it is suggested that future research should further investigate the role of different types of emotions in estimating the EVC or reward processing, in order to integrate the role of emotion into the theory of EVC.
One of the key mechanisms in the EVC framework is that if the efficacy and reward exceeds effort cost, cognitive control will be allocated [31]. Grahek and colleagues [18] suggested that expected efficacy and reward value is reduced and cost is heightened in depression. Consequently, individuals with depression do not want to allocate cognitive control over negative emotional materials, a mechanism leading to cognitive biases and maladaptive emotion regulation strategies, such as rumination. Our findings revealed that high efficacy cues can improve cognitive performance in negative emotional valence, such that no significant difference was found between the Depressed and Control groups in response to negative stimuli on high efficacy trials. In the other words, cognitive control is exerted when estimated efficacy is increased. This finding may strengthen the EVC framework for depression, as increases in efficacy can improve cognitive control over negative materials helping to reduce cognitive biases and increase use of adaptive emotion regulation strategies (e.g. reappraisal). Another implication of present findings for EVC theory is that estimating efficacy and reward is influenced by emotional valence of situation and thus worth considering in the context of depression.
Our research has several important implications. First, it is important to incorporate the role of emotion alongside motivational components into the EVC theory, which would enhance our understanding of the mechanisms involved in cognitive control allocation in depression. Second, considering that cognitive control deficits are transdiagnostic and that emerging classification methods for mental health disorders—like the Research Domain Criteria (RDoC) from the National Institute of Mental Health (NIMH; [19])—emphasize transdiagnostic frameworks across different disorders, the results of this study could help investigate the connection between the positive valence system (reward processing) and cognitive systems in a broader context.
Our research has several limitations. First, we used the emotional variant of Stroop task. It is important to note that there has been some controversy around the methodological rigor of this task. Future research should consider alternative cognitive control tasks with emotional stimulus. Second, we focused solely on testing the EVC theory within the clinical population of depression; since cognitive control deficits are present in various psychiatric disorders and co-morbidity, it would be beneficial to explore this model in other clinical conditions. Third, the study had a disproportionate representation of women. Moreover, the overrepresentation of women was more pronounced in the Depressed Group. Worth noting that, while no male–female differences have been found in large normative studies using the Stroop Task [23], gender may influence performance on emotional and reward-based tasks, and thus may affect the interpretation and generalizability of the findings. Fourth, several participants (n = 22) were excluded from the response accuracy data analyses due to poor performance. This may be result of fatigue in the experimental sessions, especially among those with depression. Finally, future studies could consider including a combination of neurological and behavioral assessments to examine the influence of emotion and motivation on neurological and behavioral reactions in depression.
Conclusion
In sum, the Depressed Group had significantly less accurate performance than the Control Group for positive and neutral words on high-efficacy trials and negative words on low-efficacy trials. The study also found that in high-reward trials the Control Group performed significantly better than the Depressed group on accuracy but not for low-reward trials. Additionally, increasing the amount of reward in the Control Group led to improved performance, but in the Depressed Group, increasing the reward resulted in a decrease in performance. In summary, our findings support certain elements of EVC theory. Specifically, in line with the suggestion by Grahek et al. [18], EVC is diminished in individuals with depression. Nevertheless, additional studies are necessary to investigate the role of emotion in assessing EVC and to determine the relevance of EVC in the context of depression.
Supplementary Information
Acknowledgements
Not applicable.
Appendix
Emotional valenced words used in the emotional stroop task
| Neutral words | Negative valenced words | Positive valences words | ||||
|---|---|---|---|---|---|---|
| Persian | English | Persian | English | Persian | English | |
| 1 | فلز | Metal | خفت | Humiliation | لذت | Pleasure |
| 2 | مردم | People | بیکس | Friendless | محبت | Love |
| 3 | آرنج | Elbow | احمق | Stupid | نجیب | Noble |
| 4 | جدول | Table | حقیر | Humble | ایمن | Safe |
| 5 | غواص | Diver | تنها | Lonely | کمال | Perfection |
| 6 | مرحله | Stage | بدبخت | Miserable | آرامش | Peace |
| 7 | دیوار | Wall | ناکام | Frustrated | خوشبو | Fragrant |
| 8 | صندلی | Chair | منفور | Hated | آسایش | Comfort |
| 9 | یونجه | Alfalfa | ننگین | Shameful | سرسبز | Green |
| 10 | شایان | Worthy | بدنام | Disreputable | برنده | Winner |
| 11 | خودکار | Pen | ناامید | Hopeless | وفادار | Loyal |
| 12 | اتفاقی | Accidental | رسوایی | Scandal | موفقیت | Success |
| 13 | دمپایی | Slipper | بازنده | Loser | اعتماد | Trust |
| 14 | گلفباز | Golfer | بیارزش | Worthless | پیشرفت | Progress |
| 15 | پادشاه | King | بیدقت | Careless | مهربان | Kind |
| 16 | دسترسی | Access | طرد شده | Rejected | خوشبخت | Happy |
| 17 | درنگیده | Delayed | بیآبرو | Dishonorable | ارزشمند | Valuable |
| 18 | صفآرایی | Line up | درمانده | Helpless | خوشبختی | Happiness |
| 19 | مأموریت | Mission | گناهکار | Guilty | شفادادن | Healing |
| 20 | اجاقگاز | Stove | بیکفایت | Incompetent | شادکامی | Joy |
| 21 | تلویزیون | Television | نخواستنی | Unwanted | روحنواز | Soothing |
| 22 | واگنباری | Freight car | کسلکننده | Boring | نیکوکاری | Charity |
Authors’ contributions
Mostafa Toobaei: Conceptualization, Methodology, Investigation, Writing, Review & Editing, Formal Analysis, Writing of the Original Draft. Mohammadreza Taghavi: Writing, Review & Editing, Supervision Laura Jobson: Writing, Review & Editing, Supervision. All authors have approved the final manuscript.
Funding
This study was supported by the Cognitive Sciences and Technologies Council (11354).
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval was received from the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1400.815) in accordance to the ethical principles and the national norm and standards for conducting Medical Research in Iran. participants signed written informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
The 10 individuals with depression were clients diagnosed with depression recruited from Psychology Clinics in Shiraz, individuals were asked to rank the words after their clinical interview/session with a clinical psychologist.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.