Remote virtual reality assessment elucidates self-blame-related action tendencies in depression

Abstract

AbstractDarwin stated that humans have a strong and involuntary tendency to perform certain actions when a specific state of mind is induced. Such “action tendencies” are key to understanding the maladaptive impact of self-blame-related feelings in depression. For example, feeling like “hiding” and “creating a distance from oneself” in a text-based task were previously associated with recurrence risk in remitted depression. Despite their functional importance, action tendencies have not been systematically investigated in current depression, which was the aim of this pre-registered study. To this end, we developed the first virtual reality (VR) assessment of blame-related action tendencies and compared current depression (n=98) with control participants (n=40). The immersive VR-task, pre-programmed on devices sent to participants’ homes, used hypothetical social interactions, in which either participants (self-agency) or their friend (other-agency) were described to have acted inappropriately. Good concurrent validity was demonstrated for VR-versus the text-based task. As predicted, compared with controls, people with depression showed a maladaptive profile: Particularly in the other-agency condition, rather than feeling like verbally attacking their friend, they were prone to feeling like hiding, and punishing themselves. The depression group showed a more pronounced slowing of response times in the other-versus the self-agency condition, which may reflect a stronger ambivalence about externalising blame in depression. Interestingly, feeling like punishing oneself was associated with a history of self-harm but not suicide attempts. Current depression and self-harm history were thus linked with distinctive motivational signatures, paving the way for remote VR-based stratification and treatment.General Scientific SummaryAs precursors of social actions, action tendencies, such as feeling like hiding when experiencing shame or guilt, provide the key link between depressive emotions and behaviour. Here, we developed a novel virtual reality task and used it in a large sample of people with depression to unveil a distinctive pattern of such action tendencies. As predicted, we found a maladaptive pattern of action tendencies in people with depression that were specifically associated with self-harm. Our findings thereby elucidate a so far unexplored key aspect of psychopathology in depression and provide important targets for the development of novel future psychological interventions tackling self-harm-related motivations and depression.