Brain of Thrones: Cognitive Effort and Perceived Performance During a Cognitive Task in Major Depressive Disorder

Cognitive impairment is a characteristic feature of depression and a robust predictor of everyday functioning. Cognitive remediation is a promising treatment for neurocognitive dysfunction in depression. However, treatment studies have shown that those with depression often do not apply their cognitive gains to everyday life. Features of depression may account for mixed outcomes, including avoidance and negative perceptions of abilities. The present investigation examined how individuals with depression engage with a novel cognitive task created to resemble exercises used in cognitive remediation. Twenty-eight individuals with depression and 24 healthy comparison (HC) participants completed a computerized cognitive task while EEG was recorded. Participants were asked to indicate how they would like to adjust task difficulty and how many of the trials they believed they got correct. Participants with depression did not significantly differ from HC on objective performance accuracy. However, participants with depression opted to decrease their difficulty level significantly more than HC on high challenge levels. Additionally, individuals with depression had significantly greater EEG alpha power on high challenge levels than low challenge levels, suggesting increased disengagement from the task on more challenging levels. Avoidance of cognitive challenges in depression has implications for understanding mechanisms related to cognitive performance and efforts to modify cognitive impairment.