The Effect of Transcranial Direct Current Stimulation (tDCS) on Attentional Bias and Affect in Adults with Major Depressive Disorder (MDD)

Document Type : Original Article


1 MSc, Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.

2 Assistant Professor, Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran



Aim: Individuals with MDD have deficits in "hot" cognition such as attentional bias to negative stimuli.They also experience low levels of positive and high levels of negative affect.This study aimed to investigate the effects of transcranial direct current stimulation (tDCS) on the ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) on attentional bias and affective state in patients with major depressive disorder. Method: The present research had a single-blinded, crossover design.Twenty-three adults with MDD received tDCS in three separate sessions with different montages: anodal dlPFC (F3)/ cathodal vmPFC (Fp2), the reversed montage and sham.Their performance was evaluated by dot- probe test (online) and PANAS questionnaire(Pre-Post Stimulation). Result: There was no significant difference between different montages of tDCS on attentional bias in depressed patients. However, a significant difference was observed in the negative affect (p<0/05). Conclusion: Attentional bias is a form of hot cognition and affects MDD patients. The present study showed no significant difference in the attentional bias scores between the three tDCS montages. However, results showed that anodal stimulation of DLPFC and cathodal stimulation of VMPFC improved the affective state of patients with MDD by reducing the levels of the negative affect.


Beevers, C. G., Clasen, P. C., Enock, P. M., & Schnyer, D. M. (2015). Attention bias modification for major depressive disorder: Effects on attention bias, resting state connectivity, and symptom change. Journal of abnormal psychology, 124(3), 463. [Link]
 Besharat, M. A., Mirzaei, T., GHOLAMALI, L. M., & Naghipoor, M. (2018). The moderating role of positive and negative affects on the association of sexual knowledge and attitude with marital satisfaction.  [Link]
Bomfim, A. J. d. L., Ribeiro, R. A. d. S., & Chagas, M. H. N. (2019). Recognition of dynamic and static facial expressions of emotion among older adults with major depression. Trends in psychiatry and psychotherapy, 41, 159-166. [Link]
Carballedo, A., Scheuerecker, J., Meisenzahl, E., Schoepf, V., Bokde, A., Möller, H.-J., . . . Frodl, T. (2011). Functional connectivity of emotional processing in depression. Journal of affective disorders, 134(1-3), 272-279. [Link]
Clarke, P. J., Van Bockstaele, B., Marinovic, W., Howell, J. A., Boyes, M. E., & Notebaert, L. (2020). The effects of left DLPFC tDCS on emotion regulation, biased attention, and emotional reactivity to negative content. Cognitive, Affective, & Behavioral Neuroscience, 20(6), 1323-1335. [Link]
Dunn, B. D., German, R. E., Khazanov, G., Xu, C., Hollon, S. D., & DeRubeis, R. J. (2020). Changes in positive and negative affect during pharmacological treatment and cognitive therapy for major depressive disorder: A secondary analysis of two randomized controlled trials. Clinical Psychological Science, 8(1), 36-51. [Link]
Heeren A, Billieux J, Philippot P, De Raedt R, Baeken C, de Timary P, et al. Impact of transcranial direct current stimulation on attentional bias for threat: a proof-of-concept study among individuals with social anxiety disorder. Social cognitive and affective neuroscience. 2017;12(2):251-60. [Link]
Gupta, T., & Mittal, V. A. (2020). Transcranial direct current stimulation and emotion processing deficits in psychosis and depression. European archives of psychiatry and clinical neuroscience, 1-16. [Link]
Kajimura, S., Kochiyama, T., Nakai, R., Abe, N., & Nomura, M. (2016). Causal relationship between effective connectivity within the default mode network and mind-wandering regulation and facilitation. Neuroimage, 133, 21-30. [Link]
Kajimura, S., & Nomura, M. (2015). Decreasing propensity to mind-wander with transcranial direct current stimulation. Neuropsychologia, 75, 533-537. [Link]
Li, B. J., Friston, K., Mody, M., Wang, H. N., Lu, H. B., & Hu, D. W. (2018). A brain network model for depression: From symptom understanding to disease intervention. CNS neuroscience & therapeutics, 24(11), 1004-1019. . [Link]
Maffei A, Goertzen J, Jaspers-Fayer F, Kleffner K, Sessa P, Liotti M. Spatiotemporal Dynamics of Covert Versus Overt Processing of Happy, Fearful and Sad Facial Expressions. Brain Sci. 2021, 11, 942. s Note: MDPI stays neutral with regard to jurisdictional claims in published …; 2021.[Link]
Majidpoor Tehrani, L., Golshani, F., Peimani, J., Baghdasarians, A., & Taghiloo, S. (2021). The Effectiveness of Combining Cranial Electrical Stimulation with Cognitive-Behavioral Therapy and Drug Therapy on Rumination and Depressive Syndrome in Women. Quarterly of Applied Psychology, 15 (4): 81, 107, 2. [Link]
Moreno, M. L., Vanderhasselt, M.-A., Carvalho, A. F., Moffa, A. H., Lotufo, P. A., Benseñor, I. M., & Brunoni, A. R. (2015). Effects of acute transcranial direct current stimulation in hot and cold working memory tasks in healthy and depressed subjects. Neuroscience Letters, 591, 126-131 . [Link]
Morgan, H. M., Davis, N. J., & Bracewell, R. M. (2014). Does transcranial direct current stimulation to prefrontal cortex affect mood and emotional memory retrieval in healthy individuals? PloS one, 9(3), e92162. [Link]
Nejati V, Khalaji S, Goodarzi H, Nitsche M. The role of ventromedial and dorsolateral prefrontal cortex in attention and interpretation biases in individuals with general anxiety disorder (GAD): A tDCS study. Journal of Psychiatric Research. 2021;144:269-77. [Link]
Nejati, V., Majdi, R., Salehinejad, M. A., & Nitsche, M. A. (2021). The role of dorsolateral and ventromedial prefrontal cortex in the processing of emotional dimensions. Scientific reports, 11(1), 1-12.. [Link]
Nord, C. L. (2017). The role of dorsolateral prefrontal cortex dysfunction in depression and its treatment with noninvasive brain stimulation. University College London. [Link]
Nord, C. L., Forster, S., Halahakoon, D. C., Penton-Voak, I. S., Munafo, M. R., & Roiser, J. P. (2017). Prefrontal cortex stimulation does not affect emotional bias, but may slow emotion identification. Social cognitive and affective neuroscience, 12(5), 839-847. [Link]
Nozari, M., Nejati, V., & Mirzaeyan, B. (2020). Effectiveness of Transcranial direct current stimulation on executive functions and amelioration of symptoms of individuals with Major Depression Disorder. Quarterly of Applied Psychology, 13 (4): 577-599. [Link]
Oliver, A., Pile, V., Elm, D., & Lau, J. Y. (2019). The Cognitive Neuropsychology of Depression in Adolescents. Current Behavioral Neuroscience Reports, 6(4), 227-235. . [Link]
Padberg, F., Kumpf, U., Mansmann, U., Palm, U., Plewnia, C., Langguth, B., . . . Burger, M. (2017). Prefrontal transcranial direct current stimulation (tDCS) as treatment for major depression: study design and methodology of a multicenter triple blind randomized placebo controlled trial (DepressionDC). European archives of psychiatry and clinical neuroscience, 267(8), 751-766. [Link]
Panchal, P., Kaltenboeck, A., & Harmer, C. J. (2019). Cognitive emotional processing across mood disorders. CNS spectrums, 24(1), 54-63. [Link]
Plazier, M., Joos, K., Vanneste, S., Ost, J., & De Ridder, D. (2012b). Bifrontal and bioccipital transcranial direct current stimulation (tDCS) does not induce mood changes in healthy volunteers: A placebo controlled study. Brain Stimulation, 5, 454-461. [Link]
Roiser, J. P., & Sahakian, B. J. (2013). Hot and cold cognition in depression. CNS spectrums, 18(3), 139-149. [Link]
Salehinejad, M. A., Ghanavati, E., Rashid, M. H. A., & Nitsche, M. A. (2021). Hot and cold executive functions in the brain: A prefrontal-cingular network. Brain and neuroscience advances, 5, 23982128211007769. [Link]
Sanchez, A., Vanderhasselt, M.-A., Baeken, C., & De Raedt, R. (2016). Effects of tDCS over the right DLPFC on attentional disengagement from positive and negative faces: an eye-tracking study. Cognitive, Affective, & Behavioral Neuroscience, 16(6), 1027-1038. [Link]
Sanchez-Lopez, A., Vanderhasselt, M.-A., Allaert, J., Baeken, C., & De Raedt, R. (2018). Neurocognitive mechanisms behind emotional attention: Inverse effects of anodal tDCS over the left and right DLPFC on gaze disengagement from emotional faces. Cognitive, Affective, & Behavioral Neuroscience, 18(3), 485-494. . [Link]
Stange, J. P., Jenkins, L. M., Hamlat, E. J., Bessette, K. L., DelDonno, S. R., Kling, L. R., . . . Ryan, K. A. (2018). Disrupted engagement of networks supporting hot and cold cognition in remitted major depressive disorder. Journal of affective disorders, 227, 183-191. [Link]
Stuhrmann, A., Suslow, T., & Dannlowski, U. (2011). Facial emotion processing in major depression: a systematic review of neuroimaging findings. Biology of mood & anxiety disorders, 1(1), 1-17. [Link]
Sylvester C, Hudziak J, Gaffrey M, Barch D, Luby J. Stimulus-Driven Attention, Threat Bias, and Sad Bias in Youth with a History of an Anxiety Disorder or Depression. Journal of Abnormal Child Psychology. 2016;44(2):219-31. [Link]
Tottenham, N., Tanaka, J. W., Leon, A. C., McCarry, T., Nurse, M., Hare, T. A., . . . Nelson, C. (2009). The NimStim set of facial expressions: judgments from untrained research participants. Psychiatry research, 168(3), 242-249. [Link]
Varma, D. (2017). Relationship of positive and negative affect with depression in clinical and normal group. Psychology and Behavioral Science International Journal, 2(1). [Link]
Winker, C., Rehbein, M. A., Sabatinelli, D., Dohn, M., Maitzen, J., Roesmann, K., . . . Junghoefer, M. (2019). Noninvasive stimulation of the ventromedial prefrontal cortex indicates valence ambiguity in sad compared to happy and fearful face processing. Frontiers in behavioral neuroscience, 13, 83. [Link]
Wolkenstein, L., & Plewnia, C. (2013). Amelioration of cognitive control in depression by transcranial direct current stimulation. Biological psychiatry, 73(7), 646-651. [Link]
Zeppegno, P. (2015). Symptoms of depression:“hot” and “cold” cognition. Editors-in-Chief Emilio Sacchetti, Claudio Mencacci, 48. [Link]