Embodied cognition and emotional disorders

Psychopathology Review PR In Press, 1-50 ISSN 2051-8315 / DOI:10.5127/pr.035714

Embodied cognition and emotional disorders: Embodiment and abstraction in understanding depression Dr. Bergljot Gjelsvik, Mr. Darko Lovric, Prof. J. Mark G. Williams, University of Oxford Department of Psychiatry, Oxford, UK.

Abstract Research into embodied cognition (EC) in cognitive neuroscience and psychology has risen exponentially over the last 25 years, covering a vast area of research; from understanding how ability to judge speech sounds depends on an intact motor cortex, to why people perceive hills as steeper when carrying a heavy backpack. Although there are many theories addressing these phenomena, increasing evidence across EC studies suggests simulation (i.e., reenactment of the motor –sensory aspects of meaning) as an important basis of knowledge. The authors 1) review evidence for the EC paradigm’s claim to simulation effects in cognition, suggesting that simulation exists within a “distributed plus hub” model, 2) discuss the implications of simulation for the understanding of cognitive dysfunctions in emotional disorders, particularly depression, 3) suggest that emotional disorders arises as a result of failed simulation processes, hypothesizing that semantic processing reactivates motor-sensory simulations previously associated with low mood (enactment/re-enactment networks), and that truncation of such simulation by means of over-use of language-based, abstract processing, motivated by a wish to reduce the affective disturbance associated with episodic, embodied representations, maintains psychopathology, 4) review evidence for effects of truncated simulation on emotional pathology, and 5) discuss the relevance of EC to treatments of emotional pathology. © Copyright 2014 Textrum Ltd. All rights reserved. Keywords: grounded cognition, embodied cognition, psychopathology, emotional disorders, depression Correspondence to: Dr. Bergljot Gjelsvik, University of Oxford Department of Psychiatry. Oxford Mindfulness Centre, Warneford Hospital, Oxford. OX3 7JX. Email: [email protected] Received 23-Jan-2014; received in revised form 30-Jul-2014; accepted 15-Sep-2014

Psychopathology Review, In Press, 1-50

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Table of Contents Introduction The Cognitive Paradigm The Cognitive Theory and Therapy of Depression The Embodied Paradigm – From Disembodied to Embodied Mind Evidence for Role of Embodiment in Cognition Challenges to Embodied Cognition: Context Specificity, “Never-Experienced” and Semantic Dementia Embodiment and Emotional Disorders Differential Activation of Enactment / Re-Enactment Networks (ERNs) Embodied Cognition and the Over-Generality of Autobiographical Memory Abstract thinking as an escape from embodiment. When Abstraction Becomes Self-perpetuating: Discrepancy-Based Processing Experimental Studies that Manipulate Level of Abstraction Clinical Studies that Increase Embodied Processing Limitations Suggestions for Further Research Conclusion Acknowledgements References Appendix A

Introduction Over the last 25 years there has been much interest throughout the cognitive sciences in the link between action, body, emotion and cognition in what has become known as the “embodied” or “grounded” approach to cognition and consciousness. This interest has been shown in cognitive neuroscience (Damasio, 1999; Garbarini & Adenzato, 2004; Tagini & Raffone, 2010; Varela, Thompson, & Rosch, 1991), philosophy (Clark, 2008; Rowlands, 2010; Shapiro, 2011) and psychology (Anderson, 2003; Barsalou, 2008; Casasanto & Chrysikou, 2011; Niedenthal, Barsalou, Winkielman, Krauth-Gruber, & Ric, 2005; Pecher & Zwaan, 2005; Wilson, 2002; Witt, Kemmerer, Linkenauger, & Culham, 2010). “Grounded” or “embodied cognition” refer to the family of theories within psychology that suggest that a necessary ground for cognition is the way our sensori-motor capacities shape and constrain our interaction with the world. These theories assert that meaning, previously understood in terms of the language of thought, as mental concepts or abstract symbols, is much more closely intertwined with (and constrained by) our bodily experience in the world than such abstract symbols allow. In other words, meaning is not something that is “distilled away from” our bodily experience, but needs instead to be critically bound up with such experience if it to function effectively (Anderson, 2003). We are interested in examining the potential implications that such “embodied” theories of mind may have for the understanding and treatment of emotional pathology. Cognitive theories of emotional disorders became prominent during the 1970s and 1980s, and were influenced by the cognitive paradigms that dominated psychological science at that time. We will use the example of the cognitive theory of depression to examine whether an embodied theory of mind offers a different, or more comprehensive, understanding of the onset and maintenance of the disorder, and if so, whether this new understanding leads to novel methods for its treatment and prevention. To this end, we will (a) briefly overview the cognitive paradigm in psychology to show how it influenced the most prominent cognitive model of depression - that of A. T. Beck; (b) review the current experimental evidence for the role of embodiment in cognition, drawing out the implications for an embodied theory of depression; (c) review evidence suggesting that emotional disorders arises as a result of deficits in simulation processes; (d) examine the implications of embodied cognition for treatment, by reviewing proof-of-principle studies that have experimentally manipulated level of processing (conceptual/abstract versus embodied/concrete) and (e) review clinical studies that show that use of body-focused methods such as mindfulness meditation can be effective in treatment where conventional cognitive methods are less so.


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The Cognitive Paradigm The cognitive view of human knowledge derived from the view that knowledge of the world was best described within a conceptual system, in which particular concepts contain semantic information about a category and knowledge is built up by links between categories. For example, consider the concept of (knowledge about) a canary. It includes several propositions: that it is a bird, that it is yellow, that it is often kept in a cage and so on. Such knowledge, interlinked with other knowledge about the world (e.g., that “all birds have wings"), allows us to infer other propositions - that canaries have wings - even if we have not closely studied any particular canary. Traditional cognitive views suggest that such knowledge is represented in a semantic system which supports and controls other cognitive activity, including most obviously language and thinking, but also other aspects of cognition such as perception and memory. According to these accounts, knowledge is abstracted from sensory/perceptual systems that originally gave rise to them, so that a concept takes on an “amodal” quality. The term “amodal” refers to the loss of modality-specific information from a concept. That is, perceptual information is lost when the concept is “abstracted away from” the sensory modalities (touching, tasting, hearing, seeing, and smelling) that were originally involved in perception, and a record of which may be needed again for retrieving specific episodic memories of the past, and for planning and executing future actions in the world. The “abstraction” that takes place, away from modal into amodal systems, has been called “transduction”. It is represented in Figure 1 (Barsalou, Simmons, Barbey, & Wilson, 2003), which shows the transduction from the neural representations of an object (a car) in vision, into another representation that is conceptual: having a feature list within a semantic network, and associative semantic links to higher order concepts (such as vehicle). In this way, an amodal system is assumed to build a schematic representation of a car that is able to re-describe sensorimotor states about cars independently of such states, and thus able to guide future perception, memory, language and thought about cars. In this article, we use the more commonly used term “abstract” to refer to such amodality. There is no doubt that this was the dominant lens through which the mind was studied from late 60’s onwards, gaining ground in the 1970s and 80s (Miller, 2003). Cognition was seen as independent of the medium, and hence independent of the neural structure of the brain, and certainly independent of the body – the human mind could be executed on a computer if we just had sufficient knowledge (Sandberg & Bostrom, 2008; Wilson & Golonka, 2013). One illustration of this approach is the pure vision paradigm of Marr (1982), in which visual processes begin with the stimulation of the retina and end with the construction of an inner model of the surrounding 3-D reality sufficiently rich in detail to allow the organism to operate entirely from the stored representations of the original perception. Marr’s research suggested that our perceptual access to the world was rather poor, and that successful navigation in a dynamic physical and social environment relied entirely on internal cognitive representations. On this view, real-world action functions merely as a means of implementing rules arrived at by pure cognition.

The Cognitive Theory and Therapy of Depression One of the first applications of cognitive theory to psychopathology was in the field of depression. Depression is a syndrome that includes emotional, cognitive, behavioral and somatic changes from normal functioning. Major depression is diagnosed if a person shows at least one of two core symptoms (feeling sad for the most of the day, or having lost interest in activities they previously enjoyed) and a further four or more of the following non-core symptoms: eating problems (significant weight loss or weight gain, an increase or decrease in appetite), sleep problems (difficulty falling asleep, waking up early or sleeping during the day); feeling slowed down (or agitated) throughout the day; feeling fatigued and exhausted; feeling worthless or excessively guilty over past actions; finding it hard to concentrate or being indecisive; and repeatedly thinking about dying or suicide. If these symptoms occur most of the day and most days of the week for more than a two week period, and they are severe enough to cause significant impairment in functioning, a major depression is diagnosable. In the 1960s and 1970’s there were some attempts to formulate a behavioral approach and treatment (see Williams, 1992 for review), but it was Seligman’s development of the learned helplessness theory of depression, linking animal and human patterns of response to uncontrollable stressors that provided the first comprehensive cognitive account of depression (Seligman, 1975). Seligman’s theory, however, had no well-worked out therapeutic implications, and it was not until Beck’s development of a cognitive theory of depression in the 1970s that cognitive therapy became


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widespread in clinical practice, proving to be the most consistently effective treatment approach (Hollon, Stewart, & Strunk, 2006).

Figure 1 Structure of amodal symbol systems and perceptual symbol systems. (a) In amodal systems, neural representations are established initially to represent objects in vision. Subsequently, however, these neural representations are transduced into another representation language that is amodal, such as feature list, semantic network or frame. Once established, these amodal descriptions provide the knowledge used in cognitive processes, such as memory, language and thought. (b) In perceptual symbol systems, neural representations similarly represent objects in vision. Rather than being transduced into amodal descriptions, however, visual representations are partially captured by conjunctive neurons in nearby association areas. Later, in the absence of sensory input, activating these conjunctive neurons partially re-enacts the earlier visual states. These re-enactments contribute to the knowledge that supports memory, language and thought. This figure illustrates knowledge acquired through vision, but analogous accounts exist for acquiring knowledge in the other modalities (e.g., audition, action, emotion). From “Grounding Perceptual Knowledge in Modality-Specific Systems” by Barsalou et al. (2003), Trends in Cognitive Sciences, p. 85. Copyright 2003 by Elsevier. Reprinted with permission.

There were three main components of the cognitive theory of depression (Beck, Rush, Shaw, & Emery, 1979). The first component was the presence of negative automatic thoughts – “automatic” by virtue of their coming “out of the blue”, often seemingly unprompted by events and not necessarily the results of “directed” thinking. Their effect was to lower mood by virtue of their global, negative, self-referent content, and for this mood shift to cause further negative thoughts and images to produce a downward spiral. The second component of the cognitive model was the presence of depressogenic schemata, ways of organizing incoming data about the self and the world, most clearly seen in long-term attitudes, developed over many years, such as “It is shameful to display one’s weaknesses”. Such attitudes are not themselves depressive but become so when an event occurs that matches the schema (e.g., becoming emotional in front of a colleague) that triggers the attitude, leading to negative thoughts (“I ought to be ashamed of myself”). Once again, the focus of the theory is the content of the long-term attitudes that arise from such schematic processing, and the content of the thoughts arising from them. The third component was the presence of systematic logical errors in the thinking of depressed individuals. Several categories were distinguished (though these were not claimed to be mutually exclusive): arbitrary inference (e.g., “my friend isn't answering her cell-phone: she must be out enjoying herself with someone else”), overgeneralization (e.g., “this always happens to me”), selective abstraction (e.g., “the nice things she says are irrelevant, it is the


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occasional criticism that shows what she really feels about me”); magnification (e.g., “if I'm late for this meeting, they'll all think I'm not up to the job” and minimization (e.g., “the boss's compliment was because she was in a good mood”); personalization, when a person attributes bad things to the self despite evidence to the contrary (“'It's all my fault”); dichotomous (all or nothing; black/white) thinking (“if she leaves me, I may as well be dead”). Here, it is the nature of the logic in language-based symbolic units that are critical to understanding the effects of thinking on mood. On the basis of this cognitive theory, Cognitive Therapy (CT; Beck, et al., 1979) was developed. It aimed to train depressed patients to notice, and then change the negative thoughts, interpretations and beliefs which maintained depression and made the person vulnerable to future episodes. The treatment included between-session homework assignments, conceived as “experiments” to test out the truth of the interpretations and gather more data for discussion. The critical assumption of the theory and therapy was that the content of the thinking was the key factor in maintaining and exacerbating the depressed mood, and although more recent statements about the factors that maintain depression refer to modes - constellations of cognitions, feelings, motivation and behaviors – the role of the cognitive aspect still prioritizes its meaning. Cognitive therapy has been very influential in the treatment of depression and has been shown to be as effective as antidepressant medication (Hollon, Thase, & Markowitz, 2002). But while the therapy represents the most effective evidence-based approach to reducing acute depression, the central tenet of the cognitive theory on which it is based has been called into question. The theory states that cognition is causal in the onset and maintenance of depression, so that changing cognition - changing the degree of belief in thoughts such as “I am worthless” - is critical to reducing depression and preventing relapse. However, a large number of studies (reviewed by Segal & Ingram, 1994) have shown that any treatment approach that successfully reduces depressed mood, including antidepressant medication (ADM), also reduces the frequency, intensity and degree of belief of negative thoughts and dysfunctional attitudes. This is important because, despite this finding of equivalent effects of CT and ADM on cognition, once these treatments are withdrawn, CT is found to have significantly greater effects in preventing future depression than ADMs (Hollon, et al., 2005). Thus, although CT is based on a theory that emphasizes that biased content lies at the root of depression (negative biases in thinking, attention, memory, judgment, and inference) the evidence suggests that such negative biases cannot be the only factor in the onset and maintenance of depression, nor that changing such cognitions are the critical mediating factor in CT, as the original theory supposed it to be. Can the recent emphasis on embodied cognition help us discern what additional critical factors there might be? First, we need to see the extent to which the cognitivist assumptions that influenced cognitive therapy for depression are better explained in terms of the embodied paradigm.

The Embodied Paradigm – From Disembodied to Embodied Mind A comprehensive account of the background to the field of embodied cognition is given by Clark (1999), Rowlands (2010), Barsalou (1999), Niedenthal et al. (2005), Anderson (2003), Anderson, Richardson, and Chemero (2012), Landau, Meier, and Keefer (2010), Caligiore, Borghi, Parisi, and Baldassarre (2010), Shapiro (2011), and Glenberg, Witt, and Metcalfe (2013). Each of these authors suggests that there are both empirical and theoretical reasons to question the cognitive paradigm that dominated psychology for the past half century that viewed cognition as processing of abstract symbols according to formal rules, in a central processor that transforms inputs into outputs (Newell & Simon, 1972). Theories of embodied cognition take many forms (Wilson, 2002; Shapiro, 2011; Wilson & Golonka, 2013). In general, however, embodied cognition theories start from the suggestion that standard, disembodied cognitive theories of knowledge have proven explanatory inadequate in several respects. For instance, Barsalou (2008) points out that there is surprisingly little empirical support for the existence of abstract representations, as well as for brain regions storing them (though see later section on semantic dementia). Moreover, it remains unclear how cognition interfaces with perception and action (i.e., the grounding problem, Anderson, 2003; Hommel, 2009). Theories of embodied cognition all share the assumption that our minds to some degree make essential demands on bodies. Claims occupying the ‘moderate’ end of embodiment theory points to how the body serves the mind, i.e., how abstract representations are critically supported and biased by sensory and motor information continuum (e.g., described as the ‘weak’ position, Rowlands (2010), or ‘offline’ embodied cognition; Wilson (2002)). A more radical version of the embodied cognition hypothesis holds that cognition is an extended system distributed over brain, body


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and environment, in which abstract representations are reduced to sensorimotor processes (the replacement hypothesis; Shapiro, 2011; described by Rowlands (2010) as the ‘strong’ EC claim). One version of this position is Jeannerod (2001) who suggests that neural simulation of action is a unifying mechanism underlying the process of intending, preparing, imagining and observing action.


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Figure 2 Multiple instances of a simulator. (a) As multiple instances of a category are encountered, neural representations of them arise in vision. Because conjunctive neurons in visual association areas are turned to particular conjunctions of visual features, a common set of conjunctive neurons captures the visual representations of the category’s instances, which tend to share visual features. Sets of conjunctive neurons in other association areas (not shown) similarly capture a category’s instances on other modalities (e.g., audition, action, emotion). In higher-order association areas (also not shown), common conjunctive neurons integrate modality-specific information for a category across modalities. (b) Once a simulator develops for a category, it later produces specific simulations of the category. On a given occasion, a subset of conjunctive neurons in the simulator produces one particular simulation in the visual system. This simulation could represent a given instance, an average of several instances, or a variety of other possibilities, depending on which subsets of stored information become active. Re-enactments typically occur on multiple modalities simultaneously, producing a multimodal simulation of the category, not just on vision (as shown). From “Grounding Perceptual Knowledge in Modality-Specific Systems” by Barsalou et al. (2003), Trends in Cognitive Sciences, p. 88. Copyright 2003 by Elsevier. Reprinted with permission.

Barsalou (1999) reviews a large number of studies which, in a similar vein, suggest that knowledge critically involves the activation of “simulation processes” as if interacting with the world. Thus, simulation is put to the fore as the basis of knowledge, in which knowledge is stored, not as abstract representations (as in “a canary is…a bird….is yellow”, etc.), but as re-enactments of perceptual, motor and introspective states that we have acquired during interaction with objects and other people in the world including and especially our own bodies (Barsalou, 1999).


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The concept of simulation has been important in many models of psychology (Baumeister & Masicampo, 2010; Paivio, 1995; Schacter, Addis, & Buckner, 2008; Shepard, 1990). However, as used in this context, simulated interaction with the environment, that is, the creation of mental experiences of perception and action in the absence of their external manifestation, is posited to be the basis of most thinking (see also Decety & Grèzes, 2006). Indeed, Wilson (2002) argues that sensorimotor simulations of external situations are widely implicated in human cognition that is allegedly ‘abstract’, such as mental imagery, working memory, and episodic and implicit memory. The replacement hypothesis (Shapiro, 2011) assumes that understanding of concepts uses the same parts of the brain that are used in directly interacting with the world. As such, simulation has been proposed as the mechanism that underlies the embodiment of cognition - rendering the postulation of abstract representations unnecessary. As pointed out by Wilson and Golonka (2013), if cognition is distributed across brain, body and environment, then the ‘states of mind’ of disembodied cognitive science will not exist to be modified. The shift from mental representations to sensorimotor simulations has been described as a radical transition from “disembodied to embodied mind” (Lakoff & Johnson, 1999) and a “recorporealization of cognition” (Heiner, 2008). The contrast with the transduction of cognitive models of meaning can be seen in Figure 2 (Barsalou, et al., 2003). This illustrates simulation works according to a ‘strong’ embodiment cognition claim (see also Wilson and Golonka (2013) for a discussion of implications of the replacement hypothesis). When we perceive, the brain captures bottomup patterns of activity in sensory-motor areas. The perceptual symbol for a car, for example, arises due to selective attention which extracts a schematic representation of perceptual components from experience and stores them in long-term memory. A set of neural feature detectors in the visual system are activated, and neurons in nearby association areas “conjoin” the active features and store them in LTM. The perceptual symbol for car is thus stored in sensory-motor systems of the brain, as records of neural states underlying perception, so that perception, imagery and conceptual knowledge depend on the same neural states. Later, in the absence of visual input, these assemblies of neurons partially reactivate the original set of feature detectors to represent car in imagery or speech. Barsalou comments (2003, page 85) “Such re-enactments or simulations are never complete and might be biased. Nevertheless they provide the cognitive-level representations that support memory, language and thought” (for a discussion of simulation properties see Barsalou (2008)). It is worth noting that within the embodied cognition literature, the terms “enactment”, “re-enactment”, “simulation”, “imagination”, “action schema”, “motor resonance”, “action-specific perception”, are often used interchangeably despite referring to potentially different phenomena. For instance, slow and deep process of re-enacting previously experienced perceptual and motor states is not necessarily the same thing as, for example, automatic activation of poly-sensory neurons (for example, visual inputs priming motor activity); or mirror neuron activation when viewing actions of others. However, whilst the relationship between the various concepts requires empirical investigation, there is sufficient convergence in the literature to suggest that simulation may serve as a useful heuristic framework for considering consequences of embodiment in general and also in understanding emotional disorders, in particular depression.

Evidence for Role of Embodiment in Cognition Previous comprehensive empirical reviews have taken account of the evidence up to the year 2000. In this section, we point to some older studies where relevant to later research, then, in Table 4 in Appendix A, present a summary of studies in this area from 2000-2013. It shows that recent years have continued to witness an increasing body of behavioral, neurophysiological and neuroimaging studies as well as lesion studies that corroborate the notion that cognition is critically dependent on the body and its interaction with the world in the way earlier reviews suggested (Anderson, 2003; Barsalou, 1999). Note that because our aim is here to review, not embodied cognition per se, but the implications of embodied cognition for the understanding of emotional disorders, the review is narrative rather than systematic, considering the different domains in which embodiment has been shown to be important. First, if motor responses are critically involved in meaning, rather than simply being a downstream consequence of perceptual interpretation, several predictions follow. First, one ought to be able to demonstrate that the neural processes involved in perceiving action and performing the same action are similar (Tucker & Ellis, 1998). Table 4 (Appendix A) shows recent studies confirming this prediction: Judging the weight of an object lifted by somebody else activates the motor and somatosensory systems that would have been activated had the individuals lifted the


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object themselves (Bosbach, Cole, Prinz, & Knoblich, 2005; Tipper, 2004; Tipper, 2010; Tucker & Ellis, 1998). Perceiving the handle of a cup activates a grasping simulation that inadvertently affects motor responses in a different, unrelated task (Tucker & Ellis, 2001). Simulating interaction with an object occurs also when reading the name of the object (Tucker & Ellis, 2004). A second prediction is that manipulation of motor activation should affect the ability to make perceptual judgments. Evidence to this effect comes from studies using transcranial magnetic stimulation (TMS), a non-invasive technique to stimulate a restricted part of the cortex and thereby enabling experimentally induced lesions. Mottonen and Watkins (2009) used TMS to disrupt the area of the motor cortex underlying lip movement (the sort of lip movement involved in saying the phonemes ‘pa’ and ‘ba’) and found that participants had more difficulty discriminating these phonemes, whereas discriminating control phonemes which involved tongue (and not lip) movement (‘ga-ka’) from each other was unaffected by the TMS. In other words, our ability to ‘hear’ sounds (usually assumed to be an ‘afferent’ activity) depends on our ability to form a motor plan (an ‘efferent’ activity). These and similar findings provides compelling evidence of the causal role of premotor cortex in processing language. These findings have been extended by studies examining the role of motor cortex in the understanding of actionrelevant language (Buccino, et al., 2005; Labruna, Fernández-del-Olmo, Landau, Duqué, & Ivry, 2011; Pulvermüller, Hauk, Nikulin, & Ilmoniemi, 2005; Willems, Labruna, D’Esposito, Ivry, & Casasanto, 2011; Gough, et al., 2012; Wallentin, et al., 2011). For instance, research into simulation effects in processing of metaphors has found that the type of action sentence affects motor activation, with participants showing the motor evoked potentials for statements such as “the man turns left” (Cacciari, et al., 2011). Simulation processes can also be seen in the domain of social and affective cognition. The first aspect of embodiment in social cognition research was concerned with the ways in which social cognition could cause bodily states, such as how activation of a person ‘stereotype’ elicits relevant motor behavior. In a paradigmatic study, Bargh, Chen, and Burrows (1996) investigated the impact of activating the elderly stereotype on behavior. Participants completed a scrambled-sentence task, containing either words priming an elderly stereotype (e.g.’old’, ‘grey’, ‘wrinkle, ‘forgetful’; with all words alluding to slowness being deliberately excluded) or neutral words. The outcome variable was the time the participants required to walk down the hallway after the experiment allegedly was over. A significant effect of priming with the elderly stereotype on walking time was found. Table 4 (Appendix A) shows that similar findings have been replicated on a lexical decision task after categorizing a series of photos of people according to whether they were elderly (Kawakami, Young, & Dovidio, 2002) and on driving tasks in a simulator (Branaghan & Gray, 2010). A second body of literature, highly relevant to our concern in this article, has examined the effect of body on cognition. Effects of bodily states on cognition have been demonstrated both in perceptual judgments of the environment, and in affective cognition. In one study, Bhalla and Proffitt (1999) asked participants, whilst carrying a heavy backpack (or not), to estimate the steepness of hills. Perceptual judgment was assessed in three ways: By providing verbal feedback (saying their judgments out loud), visual feedback (drawing a disc held by the experimenter) and haptic feedback (i.e., tilt board with flat palm rest) measures. They found that carrying the heavy backpack increased the perceived steepness of the hill. A similar overestimation of steepness was found in habitual runners who evaluated hill inclination before and after an exhausting run, and in older participants. Notably, the haptic measures were unaffected by the various physiological states, suggesting that visually guided actions and visual awareness are dissociated and that the latter is more accurate. Together the findings support the notion that a person’s ability to simulate performance of an action impacts the perception of the environment with which we interact. Table 4 (Appendix A) shows that these effects are robust: extending to findings showing (a) that carrying a backpack increases participants’ estimation of metric distance on a field (Proffitt, Stefanucci, Banton, & Epstein, 2003), (b) that larger physical body size is associated with reduced estimated distance (Sugovic & Witt, 2011) and (c) that trained athletes (traceurs - who are trained to run through urban landscapes) estimate the height of a wall as lower compared to untrained novices (Taylor, Witt, & Sugovic, 2011). These studies show how perceptual judgment is influenced by physiological capacity to interact with the environment. They help to establish an association between a physiological state and cognitive judgment. The relevance for depression is that although cognitive theory emphasizes the causal role of cognition, these data clearly show how


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the direction of cause goes both ways: bodily states (such as fatigue) can also be causal in affecting more abstract cognition such as judgments. A series of studies has documented the effect of body states on affective processing. Riskind & Gotay (1982) explicitly instructed participants to adopt either a slumped or an upright posture and found differences in behavioral helplessness, and Wells and Petty (1980) demonstrated that head movements (vertical vs. horizontal) influenced receptivity to persuasive messages irrespective of their attitudinal or counter-attitudinal character. However, these effects might potentially have been mediated by participants’ interpretation of the emotional meaning of the posture or movement. Strack, Martin and Strepper (1988) set up a situation that was less obvious for participants (holding a pen in the mouth between the teeth across the mouth or between the lips pointing forward, that is, in ways that either inhibited or facilitated muscular movement involved in smiling) and showed that these simple inhibitory and facilitating motor responses affected positive affect. Stepper and Strack (1993) further investigated whether posture mediated the effect of achievement on affective response to that achievement, and created an experimental context in which interpreting posture as an aspect of emotion was ruled out. Under disguise of investigating effect of posture on performance, participants seated either in a slumped (created by seating participants in chairs matched with lower tables), upright or normal writing posture (varied across the various tasks) performed an achievement test (a selection of Raven’s progressive matrices), and then completed a questionnaire in which the first page contained feedback about their achievement on the achievement test. All participants were told that their performance was far above average and in the top of four possible categories. Results showed that participants reported significantly higher levels of pride when in the upright position compared to the slumped position, and this effect was most pronounced when postures were adopted at the time of achievement feedback. Table 4 (Appendix A) shows more recent studies that confirm that these effects are reliable. Firming of muscles increases will-power on several parameters (e.g., ability to withstand pain, or to resist eating unhealthy food; Hung & Labroo, 2011). Friedman and Forster (2000) arranged a task so that participants extended their arm (avoidance) or flexed it (approach), a task previously found to change activation of affective and motivational systems (Cacioppo, Priester, & Berntson, 1993). The test task was the Snowy Pictures Test (Ekstrom, French, Harman, & Dermen, 1976), in which participants identify objects obscured within patterns of visual noise, and in order to integrate the fragmented stimuli to a recognizable figure, as wide attentional scope as possible is required for maximal task performance. They found that extending the arm (avoidance) resulted in impaired performance and flexing the arm (approach) enhanced performance. Further work has shown that such avoidance, as implicitly induced by arm extension, results in a larger startle reflex (Thibodeau, 2011). Williams and Bargh (2008) found that tactile experience of warmth or coldness significantly influenced the evaluation of these characteristics in others, as well as the tendency towards prosocial behavior. In a recent series of studies, Ackerman, Nocera, and Bargh (2010) extended these findings by demonstrating metaphoric-specific effects of tactile sensations on judgments: For instance, the weight of the clipboard to which a resumé is attached affects judgment of suitability for a job as well as perceptions about the candidates interest in the position (Study 1), and when given a “social survey” on either heavy or light clipboard, participants in the heavy clipboard condition allocated more money to social issues compared to the light condition (Study 2). Moreover, the authors found that sensations of texture (i.e., roughness/smoothness) influences judgment: Participants completed a simple puzzle, in which the pieces were either covered in rough sandpaper or in their usual, smooth condition, and were then asked to read a description of a socially ambiguous dialogue and rate it in terms of harshness (e.g., competitive or cooperative, friendly or hostile) and degree of familiarity between the people involved. Participants in the rough condition consistently rated the dialogue as harsher compared to participants in the smooth condition, whereas no effect of texture condition was found for the rating of familiarity (Study 3). Taken together, these studies indicate that embodied state strongly influences cognition within social settings and for affective and perceptual stimuli. It is clear that further experiments that reveal the conditions under which these phenomena are observed, and when they are not seen, will be important to help understand the underlying processes. Despite these limitations, the conclusion that the body has a “bottom up” influence on perception of the


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self, the world, and other people, and that this is not mere association, but can be causal, is important for understanding the mind.

Challenges to Embodied Cognition: Context Specificity, “NeverExperienced” and Semantic Dementia Before considering the relevance of embodied cognition theory on emotional pathology in detail, we consider three objections to the embodied cognition approach. First, some have questioned whether it sufficiently takes into account the context-specific interpretations of words (e.g., the concept “deep” in “deep-blue sea” versus “deep-frozen vegetable” to “deeply moving movie”). These seem to point to the abstract nature of concepts (Gabora, 1999). However, the extent to which words that are more metaphorical activate motor responses as part of the comprehension process is an empirical question, and the data suggest that different test tasks may be differentially sensitive to pick up such motor involvement in our understanding of idiomatic expression and metaphors that are most often used in more abstract ways. Second, others have raised the example of abstract concepts of whose referents we have never experienced, such as “the end of time” (Ohlsson, 1999). Barsalou (1999) argues that just as it is possible to imagine concepts one has never encountered (e.g., purple waterfall) and yet be able to understand them, productive mechanisms of perceptual symbols enable us to construct novel simulations of the same entities (e.g., in the case of “buttered chair” simulate a normal chair and simulate buttering it). Applying the same simulative capacity to the case of “end of time”, Barsalou (1999) suggests that we can imagine all clocks stopping or all perpetual change in the world freezing into place. Our ability to utilize past experience creatively, the theory holds, enables us to simulate entities we have never experienced, regardless of their abstract or concrete nature. But there is a third body of work that is specifically challenging to a completely embodied model of consciousness and cognition: Research on what the neural basis of semantic knowledge is, and the implications of its loss in dementia. Semantic memory refers to the aspect of our memory containing general knowledge of everyday objects and categories (e.g., knowing that a dog is an animal, as opposed to remembering an episodic detail or event about a dog you once had), and is shared across individuals in the same culture. Being able to recognize an object requires various sensorimotor details, such as vision, smell, and movement, thus, conceptual knowledge entails the activation of a widely distributed neural network. Thus, a shared notion within research on semantic knowledge is that the content of semantic memory is closely related to perception and action and that the brain regions involved in evoking a semantic memory may well overlap with or be identical with regions involved in perception and action. No-one in the field of research on semantic memory questions the essential contribution of the modality-specific components of the brain’s semantic network for representing individual attributes of our object knowledge (e.g., bananas are yellow, long and curved, sweet, need to be peeled for eating, etc.). There is, however, considerable debate about whether these distributed (i.e., non-centralized) regions provide a sufficient neural basis for conceptual knowledge. Whereas Barsalou (1999) holds that this is indeed the case, others claim that in addition to a distributed network, a "semantic hub” is crucial in order for semantic memory to function (Patterson, Nestor, & Rogers, 2007). The latter position is based partly on the fact that semantic memory requires abstraction across categories that have similar semantic significance but which do not necessarily share more specific features, and that merely a network of brain regions processing modal properties would be insufficient for the higher-order generalization characteristic of our reflective capacity as human beings to occur (Patterson et al., 2007). In other words, modality-specific visual and gustatory regions might tell us about the color and shape and taste and texture of a banana, but they would not capture the semantic similarity between bananas and, say, apples which are not yellow, not long and curved, have a very different taste and texture, etc. This claim is supported by empirical evidence from research on semantic dementia, a neurodegenerative condition affecting the fronto-temporal region (Neary & Snowden, 1996) involving progressive deterioration of conceptual knowledge about the meaning of words and the identity of objects - together with preserved visuospatial function, phonological short-term memory and mental speed. Patterson et al. (2007) conclude from the combination of cognitive deficit and lesion location in semantic dementia that, in addition to all of the modality-specific sensory and


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motor components of the semantic network, there must be a “hub” where abstract representations serve to integrate the knowledge from all of the specific regions. We suggest that the findings on semantic dementia can help to clarify the way in which semantic, abstract meanings and embodied meanings interact; that the considerable database on embodied cognition can only be brought into consistency with semantic models if one assumes a “distributed plus hub” pattern of organization. Barsalou’s model (1999) allows that abstraction takes place through a process in which sensory-perceptual information is gathered together in “convergence zones”, organized hierarchically (Barsalou, et al., 2003; Damasio, 1989). The semantic dementia evidence suggests strongly that such semantic integration takes place in specific regions in the brain, the anterior temporal lobes (ATL) where abstract representations converge and are abstracted from their perceptual and motor origin (Patterson, et al., 2007; Snowden, Thompson, & Neary, 2004). Within the “distributed plus hub” position it is argued that the ATL’s connectivity with primary sensory and motor cortices as well as with the medial temporal structures that construct new memories and process emotional responses, enables the ATL to relate a wide range of concepts across different categories (Patterson, et al., 2007). On this view, any system of meaning, no matter how much it is embodied, would require abstraction systems which, if lesioned, would mean that abstraction across modalities would work poorly or not at all (see also Grush (2003) for a philosophical argument in support of a similar position). The “distributed plus hub” account is consistent with the findings, reported earlier, that under some circumstances (e.g., metaphors and idiomatic expressions), the embodied aspect of concepts can be “washed out”. Further, it offers a framework in which we can look for evidence that such recoding into more semantic or abstract representation of previously embodied meanings might be motivated by the aversive consequences of embodied meanings. In the next section we turn to emotional pathology and suggest that several critical aspects of psychopathology arise when the system re-activates unpleasant affect, together with body sensations and action tendencies that have been learned during previous episodes of emotional disturbance, and thus motivates just such recoding into a higher level of abstraction - over-reliance on the “semantic hub”. We will suggest that this abstraction then creates the unintended consequence of further maintenance and even worsening of emotion. That is, abstraction is first used to reduce emotional disturbance, but then actually maintains and exacerbates it. In this way, embodied cognition adds to our understanding of emotional pathology by focusing not only on “horizontal” biases in content (negative versus positive) at any one level of cognition, but also on difficulties in integrating across different levels in a “vertical” hierarchy (abstraction versus embodiment).

Embodiment and Emotional Disorders In order to see the relevance for emotional pathology, let us return to the idea of the simulator (Barsalou, 1999; Barsalou, Simmons, Barbey, & Wilson, 2003, see Fig 2). Simulation as described by Barsalou (2008) and other proponents of the replacement hypothesis (e.g., Wilson & Golonka, 2013; Wilson, 2002; Glenberg et al., 2013) is a process by which partial re-enactment of the motor aspect of meaning takes place, facilitating understanding for a person and fluency of communication with others. Simulation is seen as a key mechanism that explains the now large amount of evidence that perceptual and motor variables produce effects in conceptual tasks, and that conceptual processing consistently activates modality-specific brain areas. In understanding the importance of the embodied cognition literature for emotional pathology, several aspects of the simulation process are important. First, the literature we have reviewed assumes that through repeated use of simulation as the basis of learning meanings, concepts acquire associations that link them to imagery, to emotions, body sensations and action tendencies. A strong version of the embodied cognition model would suggest that no simulation occurs without reinstatement of a “feeling tone” (pleasant / unpleasant / neutral) as well as the (at least partial) re-activation of an emotion (and associated body sensations) that have become associated with the concept and its modal enactment in the past. Second, however, not all conceptual processing is so readily “re-enactable”. Not all concepts require simulation to the same degree. As we have seen from the evidence from research on semantic dementia (Patterson, et al., 2007), modality-specific regions of brain do not capture semantic similarity, e.g., between one and another type of fruit that has very different modal qualities - different look, peelability, taste, texture, and so on. The “distributed plus hub” pattern of organization that emerges from the clinical and laboratory data (such as that on idiomatic expressions),


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suggest a hierarchical structure in which concepts vary in how readily they need to activate modal representations to be understood. Third, the re-enactment involved in simulation is a process that takes time, and so can be inhibited or facilitated by conditions in which the concept is used. We have seen that variations in the congruence or incongruence between current simulation and other parallel task demands affect speed of processing. We suggest that re-enactment may also be affected by the valence of the material that is retrieved early on in the process, and that this can facilitate or impair subsequent simulation cycles. Fourth, re-enactment in the simulator is always partial (Barsalou, et al., 2003, p. 85). Notwithstanding the data that suggests that hand gestures improve retrieval of words (Frick-Horbury & Guttentag, 1998), when people see the word “hammer” they do not generally start to actually make hammering movements. This implies two things: a) it implies that there must be a mechanism that allows the system to “know” and take account of the context for reality monitoring purposes – “is this a context in which actual action is necessary?” (Johnson, 1998; Johnson, Hashtroudi, & Lindsay, 1993; Mitchell & Johnson, 2009); b) it implies that the simulator can and does apply a “stop rule” that governs the point at which the re-enactment is truncated. The relevance for pathology emerges when semantic processing inititates a simulation (e.g., in understanding a text, or in memory search) that begins to reactivate modal systems that have in the past been associated with negative mood. Because simulation is a process that can a) start at a relatively abstract semantic level, b) is time dependent, and c) can be truncated, we suggest that partial activation of abstract systems in the early stages of simulation may be sufficient to re-enact the manifest behaviors and emotional expressions seen in emotional disorders, but also to truncate the later stages of the simulation process. Such early stopping of simulation may weaken top-down control of emotion via language, but strengthens a maladaptive network of language-based, semantic associations, taking the form of abstract ideas about the self and the world, and an attempt to process those ideas in the form of rumination. In the section that follows, we review evidence consistent with these suggestions: that simulation results in networks of association that govern re-enactment of past meanings, behaviors and affects; that over-abstraction predicts poor outcome in depression and other emotional disorders; that manipulating the degree of embodiment by inducing analytic (less embodied) versus experiential (more embodied) mode of processing affects emotional disorders. Finally, we shall examine the clinical implications of this work, reviewing outcomes of randomized trials that have used training procedures that focus on increasing experiential awareness and decreasing over-reliance on over-abstract processing.

Differential Activation of Enactment / Re-Enactment Networks (ERNs) We saw earlier that people remain vulnerable to depressive recurrence even when the usual cognitive vulnerability markers (for example dysfunctional attitudes, such as “It is shameful to display one’s weaknesses”) appear to have normalized on recovery. Differential activation theory (Lau, Segal, & Williams, 2004; Segal, Williams, Teasdale, & Gemar, 1996; Teasdale & Russell, 1983) was developed to explain this phenomenon. The theory states that it is not the “resting level” of such attitudes when in normal mood that determines vulnerability, but how easily they are reactivated by small deteriorations in mood. How does the embodied cognition account add to our understanding of differential activation of cognitive distortions by mood? Simulation involves the re-enactment of perceptual, motor and introspective states that are required during interaction with people and objects in the world (Barsalou, 1999). Whenever action is taken, there are co-occurring body states, emotional feeling/feeling tone and cognitive representations (thoughts, images, judgments, plans, comparisons, elaborations) and such co-occurrence creates associations such that when one element of the network is activated, the other associated elements are activated as well. We call these Enactment / Re-enactment Networks (ERNs). We assume (a) that some ERNs are biologically “prepared” (evolutionarily “old” associations such as those described by Seligman (1971), Mineka and Ohman (2002), and Ohman, Soares, Juth, Lindstrom, and Esteves (2012) and others on conditionability of fear (Michael, Blechert, Vriends, Margraf, & Wilhelm, 2007; Schweckendiek, et al., 2011; Vriends, et al., 2011), while others are determined by the learning history of an individual (e.g., social embarrassment; cultural taboos); (b) that people differ, one from another, in the ease with which activation of the action schema also activates associated patterns from cognitive, affective and somatic domains. It is this last property


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of the ERN network that may be most helpful in explaining how simulation processes may lead to emotional reactivity and its re-emergence and escalation of emotion, for it draws attention to the effect that mood has in re-enacting not only cognitions, but also actions and behaviors that have become associated with that mood in the past. ERNs explain the case described in Williams and Markar (1991) in which a male patient suffering from bipolar disorder hid a large amount of money when in a manic state, but could not recall where he had put it once his mood had stabilized. Some months later he became manic again, and went to hide something else, and it turned out to be the very place where he had hidden the money when last manic. Williams and Markar suggested that this was not a case of state-dependent memory, in that the manic mood had not allowed him to retrieve the location. Rather, the mood had recreated the action sequence, directing his behavior again to the identical location. They called this “statedependent re-enactment”, and the phenomenon can be explained by the reactivation of a mood that began to simulate the same action sequence previously associated with that mood. However, clinical case studies such as this are rare, so the question arises whether there are more common features of depression, seen in overt behavior, which can also be subject to experimental manipulation in the laboratory. Research on suicidal ideation and behavior has yielded two behavioral measures that are signature characteristics of those depressed patients who have been suicidal, but not seen in other depressed patients who have not been suicidal (matched for severity of depression and number of prior episodes) (a) problem-solving deficits and (b) impairment in the fluency with which positive images of the future can be generated. Table 1 summarizes a number of studies investigating these behavioral responses. Each study shows evidence of the effect of mood on re-enacting this specific aspect of behavior. The first group of studies examines problem solving performance using the Means Ends Problem Solving Task (MEPS; Platt, Spivack, & Bloom, 1975) in which participants complete a series of scenarios including an initial situation where a problem has to be solved (e.g., a person's friends are avoiding them) and a desired end-point (the person's friends like him/her again). Their task is to complete the middle portion of the story, providing means whereby the initial situation becomes the desired endpoint. The MEPS is scored for the number of "relevant means" (problem solving steps), and blind-rated for the effectiveness of the solutions produced. There is evidence that this task is powerfully related to the real-life difficulties of patients, correlating highly with their ability to solve their own problems (Rotheramborus, Trautman, Dopkins, & Shrout, 1990; Schotte & Clum, 1987). Evans, Williams, O’Loughlin, and Howell (1992) confirmed that problem solving performance was a particular problem in suicidal patients, and further research confirmed that suicidal patients had significantly more deficits in problem solving than matched psychiatric patients after covarying for level of depression (Pollock & Williams, 2001). If an association has formed between suicidal feelings and poor problem solving in the past, then the ERN theory predicts that this behavioral signature, not seen when a person’s mood is normal, will re-appear if mood deteriorates. Williams, Barnhofer, Crane, and Beck (2005) recruited people who had experienced an episode of major depression in the past – but who were currently well - and a comparison sample of people who had never been depressed. They used both clinical interview and questionnaire to divide the previously depressed group into those with and without a past history of suicidal ideation and behavior. All participants underwent a mood challenge (sad music and reading sad statements) and completed the Means Ends Problem Solving Test before and after it. The results (see Table 1) showed that, whereas all participants became significantly more sad as a result of the mood challenge, only those with suicidality in their past were impaired in their problem solving performance, generating solutions that were significantly less effective. The fact that mood challenge distinguished those with a certain behavioral history (a history of suicidality) from those without such a history (history of depression only) is consistent with the theory that past history leads to distinctive patterns of simulation that can be re-enacted under reinstatement of the mood context.


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Table 1: Clinical and Laboratory Studies of Problem-Solving and Future Fluency Behavior in Patients with a History of Suicidal Behavior Study

Sample (no. female if given)

Design / manipulation

Outcome Variable

Findings

Evans, Williams, O'Loughlin, & Howell (1992)

n = 12 patients with history of suicidal behavior, n = 12 matched control group

Comparison of patients and controls on

Inter-personal problem solving (number of relevant means and their effectiveness)

Patients with a history of suicidal behavior displayed poorer problem-solving capacity compared to controls

Pollock & Williams (2001)

n = 24 (14) psychiatric patients with history of suicidal behavior

Comparison of patients and controls on


Patients with history of suicidal behavior displayed impoverished problem-solving.

MEPS

n = 24 (14) matched psychiatric controls without history of suicidal behavior

. Means-Ends ProblemSolving Procedure (MEPS)

Means-Ends ProblemSolving Procedure (MEPS)

n = 24 (14) community controls Williams, Barnhofer, Crane, & Beck (2005)

n = 19 depressed patients with a history of suicidal ideation and/or behavior n = 15 matched depressed patients with no history of suicidal ideation or behavior n = 22 controls with no history of depression or suicidal ideation or behavior

Williams, Chan, Crane, et al. (2006)

20 (5) non-depressed (Exp. 4)

Exp. 4 & 5

40 (25) non-depressed (Exp. 5)

Comparison of MEPS performance before and after mood challenge procedure (sad music plus negative selfstatements) in patients and controls

Interpersonal problem-solving (effectiveness of means)

Random allocation to groups in which specificity of memory experimentally manipulated by using high versus low imageable cue words (Exp. 4) or by requesting either specific or generic memories in study phase (Exp. 5)


Experimental induction of more specific memories produced more effective problem solving; more abstract memories produced less effective problem solving

Comparison of performance of future fluency test (i.e., generate negative and positive instances of future events, short and long term) in DSP patients, patients hospitalized for other reasons and non-clinical controls

Ability to provide instances (number of positive and negative instances in short and long-term future)

DSP patients reported significantly fewer positive future events compared to controls for both short and long term. No differences between the three groups on ability to generate negative events.

Only patients with history of suicidal behavior showed deterioration in their problem-solving capacity from before to following mood induction.

Future fluency MacLeod, Rose, & Williams (1993)

24 (16) patients admitted for deliberate self-poisoning (DSP) 24 (17) hospitalized controls 24 (16) non-clinical controls

Psychopathology Review, In Press, 1-50 MacLeod, Pankhania, Lee, & Mitchell (1997)

43 (30) DSP patients, 27 of which were depressed, 17 non-depressed 34 (21) non-clinical controls

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Comparison of performance on future fluency task (i.e., generate negative and positive instances of future events, short and long term) in depressed and non-depressed DSP patients and non-clinical controls

Ability to provide instances (number of positive and negative instances in short and long-term future)

DSP patients (depressed and non-depressed) provided fewer positive instances of future events compared to controls but did not differ on number of negative instances provided. However both DSP groups showed a particular negative anticipation for the immediate future and for depressed DSP patients this extended to the foreseeable future (i.e., coming year) as well

O’Connor, Fraser, Whyte, MacHale, & Masterton (2008)

144 patients admitted for an episode of deliberate selfharm (DSH), all with > 1 episode of DSH

Baseline assessment of DSH patients including performance on Future Thinking Task (i.e., generate positive and negative future experiences), mood, suicidal ideation, and hopelessness used as predictors for suicidal ideation at Time 2 - 2.5 months follow up

Ability to generate positive and negative future events (number of positive and negative instances in short, intermediate and long-term future)

Specific future positive expectancy was a better predictor of suicidal ideation at Time 2 than hopelessness overall (adjusted for age, gender, baseline level of suicidal intent and mood). Negative future expectancy was not associated with suicidal ideation at Time 2.

Williams, Van der Does, Barnhofer, T., Crane, & Segal (2008)

n = 32 (19) (Study 3) participants with history of depression with or without suicidal ideation / behavior

Baseline assessment of cognitive reactivity (obtained 2 weeks prior to experimental condition) tested as predictor of change in performance on future fluency task (i.e.., generate negative and positive instances of future events, short and long term) in patients with a history of depression following a mood induction procedure (i.e., listening to sad music while reading negative sentences).

1.The Leiden Index of Depression Sensitivity (LEIDS) assessing trait cognitive reactivity

Trait hopelessness/suicidality scores on LEIDS did not predict positive future fluency prior to mood induction, but significantly predicted reduction in future fluency following mood induction even when adjusting for current symptomatology

2. Change in future fluency (pre –post mood induction)

Note: DSH = deliberate self-harm DSP = deliberate self-poisoning OGM = overgeneral memory TAU = treatment as usual

The second behavioral measure of suicidality is the degree of impairment in the fluency of generating examples of positive things that might happen in the future (“positive future fluency”). Table 1 shows four studies that confirm that this is specific to the sub-type of depression that is characterized by suicidal ideation and behavior. In order to test whether differential re-enactment takes place in such patients, Williams, Van der Does, Barnhofer, Crane, and Segal


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(2008) examined patients with varying degrees of a history of depression and suicidality, but none of whom were currently depressed. They confirmed that in this “euthymic” state, positive future fluency was normal. But following a mood induction, those who in the past had been suicidal when depressed, now showed impaired fluency of generating positive future images. Note that the studies on problem solving and positive future fluency, by themselves, do not constitute strong evidence for the role of embodied cognition in providing a novel account of the mechanisms underlying onset, maintenance and recurrence of depression. It is true that the literature on embodied cognition reviewed earlier carries the implication that such re-enactment is likely to bias the person’s perception, interpretation of language and judgments in a vicious circle. However, these phenomena might equally well be explained by existing associative learning accounts inherent in the original differential activation theory. Nevertheless the specificity of the behavioral signature is striking. It shows that reinstatement of mood brings about the return of specific action patterns. It is the implications for what effect such re-enactment has for people who are vulnerable to such re-emergence of symptoms that is important and to which we now turn. We saw earlier that the data on embodied cognition is best described within a “distributed plus hub” pattern of organization: a hierarchical structure in which concepts high in the hierarchy vary in how readily they need to activate representations lower in the hierarchy to be understood. We also saw that partial activation of abstract conceptual structures in the early stages of simulation may be sufficient to re-enact the lower-level behaviors and emotional expressions seen in emotional disorders and that re-enactment includes specific action patterns and deficits that reemerge when mood is disturbed. What effects does this have? Recall that the simulation process takes time, so on this view can be truncated if it begins to re-activate strong affect and body sensations, and re-enact maladaptive actions. In those with a longer or more severe history of adversity, such truncation may occur more frequently. This failure to move vertically down the hierarchy from abstract to more sensory–perceptual modes of cognition results in a horizontal move across the same level of the hierarchy, strengthening a maladaptive network of language-based associations, more abstract ideas about the self and the world, and rumination as an attempt to control such abstract ideas (Watkins, 2008). The result is over-abstraction in thinking, seen most clearly in a lack of specificity in retrieval of autobiographical memory. In the section that follows we will describe how people with depression exhibit such over-abstract processing shown in over-general errors in retrieval.

Embodied Cognition and the Over-Generality of Autobiographical Memory Autobiographical memory is episodic memory for personally experienced past events. It is critical to human functioning individually and interpersonally (Neisser, 1986; Tulving, 2002). It contributes to an individual's sense of self and to her ability to remain oriented in the world. It is vital for pursuing current and future goals in the light of past successes and failures in problem solving, and is particularly important for interpersonal goals, where autobiographical memory arises from and then, in turn, contributes to a shared social world (Conway & PleydellPearce, 2000; Nelson & Fivush, 2004). Early studies of mood and memory were concerned mainly with mood congruent biases - the increased probability or speed of retrieval of negative memories when in negative moods (see Fox, 2010, for review). However, of particular interest to the field of embodied cognition is the finding, first made by Williams and Broadbent (Williams & Broadbent, 1986) using the Galton-Crowitz cue-word paradigm, that patients with depression show another deficit: they retrieve personal memories in an over-general way, failing to retrieve one specific episode. For example, to the cue word “happy”, they may say “When I used to take my dog for walks” rather than “When I took my dog for a walk and he got lost”. The methodology involves the presentation of cue-words varying in emotional valence. Participants are asked to respond to each cue-word with an event that the word reminds them of. They are told that the event recalled can be important or trivial, recent or from a long time ago, but that it should be a specific event, something that happened at a particular place and time and lasted for a day or less. Participants are given an example of what is meant by ‘specific’ (to the word ‘enjoy’ it would not be okay to say ‘I always enjoy a good party’, because that does not mention a particular time, but it would be okay to say ‘Jane’s party last month). They are given practice trials to confirm that they have understood the instructions.


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The importance of the over-general memory phenomenon is that it shows how abstract thinking can be a risk factor. Over-general memory increases the risk for new onsets of depression in adolescents and young adults (Anderson, Goddard, & Powell, 2010; Gibbs & Rude, 2004; Rawal & Rice, 2012; Sumner, Griffith, & Mineka, 2010). Further, over-general memory also delays recovery from episodes of affective disorders (Brittlebank, Scott, Williams, & Ferrier, 1993; Dalgleish, Spinks, Yiend, & Kuyken, 2001; Harvey, Bryant, & Dang, 1998), thus exposing patients to more affective disturbance throughout their lives. Why does over-general memory occur? Williams et al.(2007) suggest that it is a particular feature of voluntary (topdown) retrieval in which relatively semantic cues are used as the first step in the iterative search for the memory (see Figure 3). Such retrieval starts with elaborating the cue semantically, and moving through generating generic descriptions to more specific mnemonic material (see Haque and Conway (2001) for experimental data showing that abstract knowledge predominates early retrieval of autobiographical memories). Early in generative retrieval, more verbal/abstract representations are involved, and more sensory/perceptual (modal) code is used later in the process.

Figure 3. Hierarchical processes in generative retrieval. The Figure shows schematically what is assumed to occur in cue word retrieval. Retrieval starts with elaborating the cue semantically and moving through generating generic descriptions to more specific mnemonic material. Early in generative retrieval, more verbal–abstract code is involved, and more sensory–perceptual code is used later in the process. Williams et al. (2007), Psychological Bulletin, p. 13. Copyright American Psychological Association 2007. Reprinted with permission.

We suggest that early stages of self-generated search involve the use of abstract representations (at least for adults – children appear to depend more on perceptual systems for encoding and retrieval; Maril, et al., 2011). These verbal/abstract (self-related conceptual) information packages are used in assembling mnemonic cues to aid the search for episodic information. The goal of retrieval is production of a specific episode as output, but this goal can be subverted.

Abstract thinking as an escape from embodiment. The tendency to rely on abstract, over-general memory arises because people are motivated to avoid retrieval of any episodic information that would create large emotional disturbance. Truncating the search when only intermediate


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descriptions have been accessed is one way to avoid such disturbance, i.e., passive avoidance of negative episodic representations and associated affect (Figure 4).

Figure 4 When simulation processes activate aversive embodied meanings. The Figure shows schematically what is assumed to occur in accessing word meanings through simulation. Initial understanding starts at abstract level of hierarchy, elaborating the cue semantically and moving through generating generic descriptions to more specific, embodied material. More verbal–abstract code is involved early in simulation, and more sensory–perceptual code is used later in the process. However, fragments of embodied information are activated relatively early (denoted by the perceptual/sensory triangle on the left hand side reaching towards the abstract domain). Note (a) truncation is not limited to negative concepts - aversive sensory information can be linked to “positive” concepts such as “holiday”; (b) despite truncating simulation as attempt to avoid aversive re-enactments, people with a history of adversity continue to find intrusive material from specific environmental cues (sights and sounds) activating emotions in an “bottom up” way.

Williams et al. (2007) reviewed a number of studies showing that more episodic detail can be associated with greater affective disturbance, and that over-generality is functional in reducing such disturbance. Research has also found that such avoidance motives may be re-activated experimentally. Debeer, Raes, Williams, and Hermans (2011) found that students scoring highly on a scale of avoidance were less specific in their memory when told that word-cues might sometimes elicit negative memories, but not if told that the test of memory was simply to establish re-test reliability. While an alternative account to the one that depressed and non-depressed people differ in how negative memories are cued is that these two populations have different memories (i.e. depressed people have more negative memories, so they are more likely to become active) studies that experimentally manipulate over-generality in the laboratory show that the effect of over-generality can be causal: non-depressed participants become impaired in their problem-solving when their memory is made to be over-general (Williams, Chan, Crane, Barnhofer, Eade & Healy 2006). Notice that the literature on over-generality in autobiographical memory is consistent with the embodied cognition literature in emphasizing not the content of autobiographical memory, but rather the level of abstraction in which that


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content is expressed. It raises the possibility that, in some clinical contexts, problems arise for patients because their cognition is not sufficiently grounded: It is too abstract and conceptual, not sufficiently specific, perceptual and episodic (Watkins, 2008). We suggest that it is the lack of the ability to draw on more embodied information that is maladaptive.

When Abstraction Becomes Self-Perpetuating: Discrepancy-Based Processing We have suggested people tend to adopt over-abstract level of thinking as an attempt to reduce affect. However, once this strategy is adopted, this level of processing itself brings its own problems in that some individuals repeatedly use language-based, abstract processing to attempt to solve emotional problems through reducing discrepancies (e.g., “I want to be happy – I am unhappy”). In this section, we consider how such discrepancy-based processing results in worsening affect (see also Williams, 2008). Normally, the smooth goal pursuit that characterizes daily life relies on automatic use of discrepancy-based processing, that is, the continuous weighing up of alternative goals against their relative importance to the person, and choosing one for pursuit (see Duncan, 1993 for more details). For each alternative candidate goal that might be pursued, three aspects are required to be held in working memory to allow people to check their progress in getting to the goal: (a) the current situation (b) the goal and (c) the possible actions needed to close the gap. For external problems (e.g., taking a pet to the veterinary clinic for immunization shots), the discrepancy-based mode of processing can operate relatively fluently because the checking mechanism does not itself affect the external circumstances (checking how far it is to the clinic does not affect the actual distance left to travel). However, when the same mode is activated as a way to reduce emotional distress, several aspects can make things worse. In such instances, discrepancy-based processing can backfire. For example, let us assume that the goal in question is a self-relevant high-order goal such as “to be happy” and the current state is a sense of sadness. In this case, because the person has registered that the current state is not how they want it to be, the same discrepancy-based processing mode that works well for external problems is automatically activated. In this case, checking the degree of discrepancy and finding a mismatch (comparing how I feel with how I’d like to feel) can actually increase distress (“I wish I were happier”), and thereby increase the discrepancy, so that the goal (feeling better) is further away from being realized. Note that discrepancy-based processing needs to hold in working memory a representation of the current state of affairs, as well as the desired state of affairs so that the gap between them can be monitored. And because what are maintained are language-based representations, the operations that are activated to reduce the discrepancy between current and desired states use the same level of representation – they too are language-based. The person starts to ruminate about and elaborate these thoughts. Many research studies find that attempts to “problem solve” using ruminative/analytic processing actually reduce problem solving capacity and maintain and exacerbate depression (Lyubomirsky & Nolen-Hoeksema, 1995; Watkins & Baracaia, 2002). In summary, the attempt to simulate an adequate behavioral response to an emotional difficulty using language-based (abstract) representations may have exactly the opposite effect to that intended. Table 2 summarizes the evidence that use of such language-based, abstract processing affects the course of emotional pathology. The Table focuses first on major depression, in which situations are typically interpreted in a global, abstract negative way (“My lower than expected grade on this test means I will fail in everything I ever attempt”). Importantly this abstract process can be activated by the evidence of one’s own mood: “This feeling sad means I am a failure” (Beck, et al., 1979) leading to “depression about depression” (Teasdale, 1983). Such processes, giving rise to ruminative cognitive patterns, has been shown to be particularly pronounced in cases of low goal success and high goal importance (Moberly & Watkins, 2010).


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Table 2. Studies of whether abstract level interpretations of symptoms predict maintenance of emotional disorder Study

Sample(no female if given

Design / Manipulation

n = 62 (39) clinically depressed patients

Baseline measures of autobiographical memory: The presence of spontaneous intrusive memories of stressful life events (assessed by Impact of Event Scale including intrusions and degree to which they are responded to by avoidance) and performance on the Autobiographical Memory Test measuring overgeneral memory (OGM). Level of intrusion and avoidance + depression level reassessed at 6 months follow-up

Outcome

Variable

Depression Brewin, Reynolds, & Tata (1999)

n = 52 at 6 months follow-up

Moulds, Kandris, Williams, & Lang (2008)

n = 18 dysphoric patients experiencing intrusive autobiographical memory within < 7 days

Cross-sectional exploration of beliefs associated with intrusion (e.g., ‘I am weak not to be able to control this memory’) and safety behaviors prompted by beliefs (assessed by Safety Behaviours and Intrusive Memories Questionnaire)

OGM was associated with greater levels of spontaneous intrusion of stressful memories. OGM did not predict outcome at 6 months, but depression at follow-up was predicted by the amount of intrusion and avoidance of stressful memories, even when taking initial severity of psychiatric symptoms into account

Safety behavior

Seventy-one percent of participants who endorsed the belief ‘Because I’ve had this intrusive memory, what I’m doing will be ruined’ engaged in a safety behavior in response. The beliefs ‘I must regain control of this memory’ and ‘I should be able to rid my mind of this memory’ prompted the use of a safety behavior (56% and 53% of patients reporting this belief, respectively). A range of types of safety behaviors were elicited, the most common being cognitive distraction.


Newby & Moulds (2010)

n = 85 participants

Newby & Moulds (2011)

n = 85, of which

Williams & Moulds (2008)

(25 depressed, 30 recovered depressed, 30 never-depressed)

n = 64 followed up at 6 months

n = 250 undergraduate students having experienced intrusive autobiographical memory within < 7 days

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SCID-I/NP (First et al., 1996), mood measures, and self-report questionnaires that indexed intrusive memory frequency and avoidance, appraisals and strategies used to manage the memories

Safety behavior

Depressed participants endorsed higher ratings of negative appraisals of intrusive memories than the never-depressed group, with the recovered group reporting intermediate ratings across most appraisal themes. Depressed individuals reported more safety behaviors and passive strategies in response to their memories than the other two groups.

Negative appraisal and avoidance strategies in response to intrusive memories + depression level assessed at baseline

Depression at 6 months

In subgroup who received no treatment, negative appraisals of intrusions predicted depressive symptoms at 6 months (adjusting for baseline depression level) whereas avoidance was not predictive.

Examine the association between negative appraisals of intrusive memories, attempts to control intrusions, and distress from intrusions.

Intrusion quality, frequency, associated distress and response to intrusions

Responding to memory with negative appraisals and attempts to control it were positively associated with intrusion-related distress, level of depression, and cognitive avoidance mechanisms.

Baseline: interview about presence of intrusions, their qualities and associated distress and reactions to them (i.e., suppression)

Degree of suppression

Vividness, associated distress and ruminative response to intrusions significantly correlated with concurrent PTSD severity in both studies, and also predicted PTSD severity 6 months later in

PTSD Michael, Ehlers, Halligan & Clark (2005)

Study 1: n = 81 (33) Previously experienced assault Study 2: n = 73 (33) all victims of assault < 3 months prior to inclusion

At 6 months follow-up: Intrusion Provocation Task, i.e., exposure to photos depicting assaults. After 2 minutes: presence of intrusion related to experienced assault + degree of intrusionrelated distress in general and their qualities (e.g., vividness, frequency) assessed

Study 2. Efforts to suppress intrusions correlated significantly with PTSD symptom severity in the concurrent assessments in both studies, but failed to significantly predict subsequent symptom severity.


Dunmore, Clark & Ehlers (1999)

n = 91 (44) all victims of physical/sexual assault < 3 months prior to Inclusion

Cross-sectional comparison of cognitive factors in no PTSD vs. PTSD group and between subjects with persistent vs. recovered PTSD. Assessed PTSD symptoms, nature of assault and

Response to intrusions

responses to intrusions

Dunmore, Clark & Ehlers (2001)

Steil & Ehlers (2000)

n = 57 (31)

PTSD Symptom Scale Semi-structured interview about assault

Symptoms at 6 and 9 months

Cognition and behavior questionnaires assessing response to intrusions

n = 159

Perceived threat to life

n = 138

PTSD Symptom Severity

all victims of motor vehicle accident

Intrusion frequency and associated distress

Control strategies (rumination, suppression, distraction)

victims of motor vehicle accident

PTSD screening at 3 months to assess predictors of symptom severity at 12 months

Cognitive processing style during assault; appraisal of assault sequelae; negative beliefs about self and world; and maladaptive control strategies (avoidance/safety seeking). Cognitive variables significantly predicted PTSD severity at 6 and 9 months. Relationships between early appraisals, control strategies, and processing styles and subsequent PTSD severity remained significant when adjusting for gender and perceived assault severity.

The dysfunctional meaning of posttraumatic intrusions predicted coping strategies that have been found to maintain intrusive cognitive phenomena, avoidance of reminders (PAQ), thought suppression, rumination, and distraction. These explained a substantial proportion of the variance in these variables even when the influence of intrusion frequency, accident severity, general anxiety-related catastrophic cognitions, and general beliefs about how best to deal with distressing cognitions were controlled for.

Tendency to avoid of reminders of the accident

n = 967

Appraisal of aspects of the assault itself, of the sequelae of the assault and dysfunctional strategies (avoidance/safety seeking) predicted onset and maintenance of PTSD. Cognitive factors associated only with the onset of PTSD were: detachment during assault; failure to perceive positive responses from others and mental undoing. Relationships between appraisal variables and PTSD remained significant when adjusting for variations in perceived and objective assault severity.

Objective and subjective assessment of accident severity little or no bearing on onset and severity of PTSD.

Frequency of dysfunctional beliefs about intrusions (Intrusions Cognitions Interview)

Ehlers, Mayou, & Bryant (1998)

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Rumination Negative interpretations of intrusions

Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year.


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The Table also summarizes a number of studies of post-traumatic stress disorder (PTSD) 1. Although a highly prominent feature of PTSD psychopathology is the intrusive, involuntary “flashbacks” of traumatic events, these studies suggest that it is the language-based interpretations of these flashbacks as evidence of weakness, imminent mental illness, permanent irreversible damage or future hopelessness that serve to maintain symptoms that might otherwise extinguish (Kleim & Ehlers, 2008; Kleim, Ehlers, & Glucksman, 2007). Consistent with this, research has found that the comparative inability to separate emotions from an event in the cognitive representation of such negative events (poorer cognitive-emotional distinctiveness, CED) is associated with worse mental health (Boals, Rubin, & Klein, 2008), as well as being a key marker of PTSD (Boals & Rubin, 2011). How far does the present evidence support this theory of psychopathology? In the next section we consider the evidence to evaluate to what extent embodied cognition theory sheds new light on clinical theory and practice by examining studies that have manipulated the level of abstraction with which participants process self-related information. Table 3. Studies using experimental manipulation of abstract/analytic versus concrete/embodied processing on mood and cognition Study

1


Manipulation

Outcome Variable

Findings

Watkins & Teasdale (2001)

36 (25)

Attentional task in which focus of attention (high vs. low self-focus) and thinking style (high vs. low analytical thinking) were manipulated.

Autobiographical recall (Autobiographical memory test, AMT) + level of despondency and depression assessed pre- and post-manipulation.

Analytical thinking style increased overgeneral memory whereas high degree of self-focus increased negative mood following the attentional task

Watkins (2004)

69 (39)

Stress-failure task followed by writing about exp. Induced failure either with high abstract level of processing (‘why the event happened’conceptual/evaluative condition) or low level of abstraction (‘how did you feel from moment to moment?’ – experiential condition).

Trait rumination assessed as moderator.

High level of trait rumination in the conceptual/evaluative condition led to a significantly greater drop in positive mood following the failure compared to high ruminators trained to adopt a concrete level of processing of the same event (as well as compared to low ruminators in both groups)

Emotional reactivity

Post traumatic stress disorder (PTSD) is diagnosed in individuals who have been exposed to a traumatic event during which they experienced intense fear, helplessness or horror experiences, and who persistently re-experience the event (for example through dreams, flashbacks, reliving the event, distress or physiological arousal in response to internal or external cues that remind them of the event), who show persistent avoidance of stimuli associated with the trauma, who show a numbing of responsiveness and who have symptoms of increased arousal (e.g., difficulty sleeping, hypervigilance, irritability, exaggerated startle response). These symptoms must be present for at least one month and cause significant distress of impairment in functioning. Acute stress disorder is diagnosed if the duration of symptoms is less than three months.


Watkins & Teasdale (2004)

Watkins & Moulds (2005)

28 (21)

Trained to adopt either analytical mode or moment-to-moment awareness of symptomfocused items in rumination task (e.g., ‘ the physical sensations in your body’

AMT-test and measure of positive and negative affect pre- and postmanipulation of selffocus. Overgeneral memory and emotional reactivity

Experiential self-focus reduced OGM compared to analytical self-focus. Levels of self-focus did not affect mood differentially

40 (29) depressed

Trained to adopt either analytical mode or moment-to-moment awareness of symptomfocused items in rumination task (e.g., ‘the physical sensations in your body’).

Performance on Social problem solving (SPS, items from MEPS) assessed pre and post manipulation of symptom-focus.

SPS performance enhanced by concrete self-focus in depressed patients compared to abstract selffocus

Focus on positive and negative scenario in either abstract/analytical or concrete/process-focused mode of processing, followed by failure task

Trait level assessed.

High levels of trait rumination were associated with reduced positive affect for participants in the abstract/evaluative condition and not for participants in the concrete, process-focused condition.

40 (25) neverdepressed

Moberly & Watkins (2006)

Raes, Hermans, Williams, & Eelen (2006)

25

69

48 (48) (Study 2) low-specific on AMT

Participants induced to retrieve memories in an overgeneral or specific mode + puzzle task serving to induce failure

Emotional reactivity following failure

Level of distress following negative event

Participants trained to retrieve memories in an overgeneral way reported higher level of distress following a negative event compared to participants who were trained to retrieve memories in a specific way.


Watkins, Moberly, Moulds (2008)

40 (Exp. 1)

63 (Exp. 2)

40 (Exp. 3)

Watkins & Moberly (2009)

39 (21) depressed

a) Induced to think about negative and positive scenarios either with abstract/analytical or concrete level of processing (Exp. 1 and 2) or interpretative-bias lexical task (completing ambiguous sentence by completing last word priming either an abstract or concrete level of processing) and lexical recognition task (completing word of sentence in way congruent with mode of processing in the previous task, e.g., ‘hear the murmurs of words’ vs. ‘hear the murmurs of resentment; Exp. 3). b) Anagram stress-task including experimentally induced failure.

Relaxation training condition (RT; 20 minutes progressive muscle relaxation procedure + exercise x7 at home via CD ) or RT + concreteness training (CNT; e.g., focus on sensorimotor aspects of presented scenarios + own experience, total 70 minutes + exercise x7 at home via CD).

Watkins, Taylor, Byng, Baeyens, Read, Pearson & Watson (2012)

121 (Major Depression Disorder)

Participants randomly allocated to TAU, TAU + RT, or TAU + CNT (RT and CNT both involving pre-treatment assessment, up till 6 weeks of home assignments and three phone contacts during this time).

Note: OGM = Over-general memory MEPS = Means Ends Problem Solving Task

Pre- and posttest assessment of emotional reactivity (degree of despondency in Exp. 1 and 2, level of negative and positive affect Exp. 3) and current degree of self-focus

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Across all three studies, negative mood (similar to observed in depressive rumination) (despondency in Exp. 1 and 2, higher level of negative affect and reductions in positive affect in Exp. 3) increased in abstract-analytical condition compared to lower-level condition following the experimentally induced failure, whereas more concrete level of processing (induced by lower-level condition) reduced subsequent emotional reactivity. Moreover, processing the failure on a concrete level (‘how the event happened’) was associated with less emotional reactivity (i.e., less reduction in positive mood and smaller increase in negative affect) following the failure task

Mood and level of rumination assessed at baseline and after participants confirmed x7 sessions.

Condition combining RT+ CNT led to significantly greater decreases in depressive symptoms and marginally significantly greater decreases in state rumination than RT alone.

Depression level assessed pretreatment and at 8 weeks after randomization

TAU+ CNT led to alleviation of depression level post treatment. No differential effect of RT and CNT respectively on symptom reduction, though CNT outperformed RT in reducing rumination and overgeneralization at followup.


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Experimental Studies that Manipulate Level of Abstraction An implication of the empirical evidence for the debilitating effects of abstraction is that one ought to be able to demonstrate that processing the same content at a more concrete, experiential level, rather than an abstract level, would alleviate symptoms. Table 3 shows the results of studies in which participants process self-relevant material in different ways. These use a paradigm developed by Watkins and Teasdale (2004) to experimentally manipulate the level of abstraction in self-focus by asking participants to focus on the same material for 8 minutes (e.g., “how awake or tired you feel”) and either focus on the causes, meanings and consequences of the item content (abstract, analytic processing), or focus on the experience of the item (concrete, experiential processing). Table 3 reveals an important pattern. Concrete, experiential self-focus increases memory specificity, enhances social problem-solving, reduces emotional disturbance following experimentally induced failure in depressed individuals compared to abstract processing of the same content (Raes, Hermans, Williams, & Eelen, 2006; Watkins, Moberly, & Moulds, 2008; Watkins & Moulds, 2005; Watkins & Teasdale, 2001, 2004). A further striking demonstration of the effect of level of abstraction with which self-related material is processed is shown in Table 3, in an experiment on eating disorders in non-patient and patient samples. Rawal, Williams, and Park (2011) used Watkins’ paradigm in which participants spent eight minutes in either analytic or experiential processing mode, after which they imagined eating a large fattening meal for two minutes (the Eating Stress Task; Shafran, Teachman, Kerry, & Rachman, 1999). Results showed that concrete, experiential processing significantly immunized against adverse reactions, including the perceived increase in weight usually observed after such a stress test. This experiment, together with those of Watkins and colleagues on abstract versus concrete processes in rumination, is consistent with a new approach to understanding and prevention of emotional disorders that explicitly changes the level at which negative material is processed, rather than tries to change the content of such material. What might such an approach add to existing cognitive therapy approach to depression?

Clinical Studies that Increase Embodied Processing We have seen that cognitive theory and therapy has been very influential in the treatment of depression and has been shown to be as effective as antidepressant medication (Hollon, et al., 2002). Despite its success, however, there is a substantial proportion who is not helped by the approach. Hollon et al. (2005) reported that antidepressants and CT achieved comparative results in the short-term (57 per cent remission after 16 weeks of either ADM or CT respectively), but in the year following treatment cessation, 75 per cent of the ADM group had relapsed, compared to only 31 per cent of those who had received CT. But this difference from ADM easily distracts from the finding that because only 57 per cent of patients had achieved remission at the end of the 16 weeks of CT, and in the following year, 31 per cent of those who had achieved remission had relapsed, then the real effectiveness of CT at treating depression and then helping patients to stay well for 12 months is 39 per cent, with the other 61 per cent relapsing back into major depression in the 15 months after the start of treatment. Most likely to fail to respond, and to relapse quickly after initial response, are those with the most severe and longest histories (Nanni, Uher & Danese, 2012). The need to find novel approaches that help those who are most likely to relapse is urgent. Can a treatment approach that focuses not on changing content (the horizontal dimension) but rather on increasing embodied, experiential processing and decreasing reliance on abstract processing (the vertical dimension) be effective? Motivated by the findings on over-generality in autobiographical memory, Serrano, Latorre, Gatz, & Montanes (2004) demonstrated that retrieval practice to increase specificity in elderly depressed patients decreased hopelessness and depressive symptoms in general as well as led to improved life satisfaction, and that these effects were mediated by increased autobiographical memory specificity. Similarly, Raes, Williams and Hermans (2009) demonstrated that memory specificity training (MEST) decreased depressive symptoms, rumination and experiential avoidance, and increased problem-solving skills through increasing the specificity with which depressed patients retrieved personal memories. A recent study of depressed participants at high risk for recurrent episodes showed that even very short periods of MEST enhanced their mood and ameliorated depressive symptoms, in ways that were not attributable to improved mood itself (Neshat-Doost, et al., 2013).


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The laboratory findings on the changes brought about by manipulating level of abstraction versus concreteness have motivated two clinical studies (Watkins & Moberly, 2009; Watkins et al., 2012). These both show that a treatment that is consistent with the embodied cognition literature, focusing on reducing abstraction and increasing experiential, sensory / perceptual detail significantly reduces depression in clinical samples. Finally, an approach called mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2013) deliberately focuses on shifting from an abstract, language-based mode, to concrete, embodied and experiential mode of processing. Two studies have showed that MBCT brings about greater specificity in autobiographical memory (Williams, Teasdale, Segal, & Soulsby, 2000; Heeren, Van Broeck, & Philippot, 2009). Eight trials have evaluated the impact of this training on major depression, and find that it reduces risk of relapse by an average of 43 per cent, and is as effective as antidepressants in doing so (Bondolfi, et al., 2010; Godfrin & van Heeringen, 2010; Kuyken, et al., 2008; Ma & Teasdale, 2004; Segal, et al., 2010; Teasdale, et al., 2000, van Aalderen et al., 2012, Williams et al., 2013). Most of these trials compared MBCT to treatment-as-usual, and so did not control for nonspecific factors such as being in a group, sharing experiences of depression and feeling accepted and understood. However, Williams, et al., (2013) included an active psychological treatment control condition (Cognitive Psychoeducation) to control for such non-specific factors. Results showed that this active control achieved only half the size of effect of the MBCT treatment that included mindfulness practice. Importantly, these studies show that this approach is more effective with the most vulnerable patients: those who have had more prior episodes (Teasdale, et al., 2000; Ma & Teasdale, 2004) those who have early onset and have suffered childhood trauma (Ma & Teasdale, 2004) and those who start treatment with residual symptoms (Segal, et al., 2010). Consistent with this pattern of results, Williams et al. (2013) found that MBCT significantly reduced risk of relapse in the most vulnerable (patients with early trauma and adversity), even though they did not find an overall effect of MBCT compared to controls in their sample as a whole. Factors such as early onset and history of trauma are the patterns of symptoms that predict a poor response to CT (Nanni, Uher, & Danese, 2012), and suggest that an approach that emphasizes the importance of embodiment can be complementary to existing CT approaches.

Limitations The current paper has several limitations. First, there is currently not sufficient evidence to support the claims of full simulation. For instance, although behavioural studies reveal speeded congruent responses between objects/words and actions, this does not necessarily imply that an entire simulation of an interaction sequence has occurred. For these behavioural effects to be observed, it is sufficient only that a particular word primes its semantic actionassociations or that one element of a response is activated 2. While the empirical evidence does not yet make it clear to what degree an ‘as if’ simulatory basis for cognition implied by the replacement hypothesis (Shapiro, 2011; Wilson & Golonka, 2013) is supported, we nonetheless consider simulation a promising heuristic framework to consider the significance of this field of research for our understanding of emotional disorders. Second, despite increasing recognition of the transdiagnostic processes across various emotional disorders, the role suggested here for Enactment/Re-enactment Networks (ERNs) in maintaining depression derives from research into biases in recurrently depressed patients. While it is theoretically plausible to assume that this also holds for emotional disorders at large (e.g., PTSD, anxiety disorders) this requires further specific consideration for each type of psychological problem. Third, the aim of the current paper was to review not embodied cognition per se, but the implications of embodied cognitions for the understanding of emotional disorders. Thus, the review is narrative rather than systematic, which means that it is possible that some studies that were omitted may have implications for other subfields of psychology other than the clinical field we are concerned with in this article.

Suggestions for Further Research Despite these limitations, we suggest that the increased interest and research in embodiment within cognitive neuroscience, philosophy and psychology does indeed offer new ways of understanding psychopathology and its treatment. Although the embodied cognition framework does not currently represent one readily falsifiable theoretical

2

We are grateful to an anonymous reviewer for pointing this out


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corpus, it nevertheless provides a useful heuristic framework for developing more detailed and testable explanatory models. This heuristic framework can motivate experiments which in turn can test an embodied cognition theory (in which abstract-analytical patterns of processing are seen to maintain emotional disorder) in a range of clinical outcomes. It is beyond the scope of this article to conclude whether such outcomes would be uniquely predicted by this theory. We would however like to point to two clinical fields, addiction and suicidal behavior, where the model makes testable predictions. Recent models of pathological addictions have suggested that, given the impoverished response inhibition displayed in such behavior (e.g., persistent risky choices, continued drinking or gambling to cover losses), more abstract processing (e.g., modify evaluation of reward outcome by bringing to mind the thought of the financial security of one’s family) might be adaptive when exposed to cues which reactivates urges (e.g., walking past a liquor shop) and where risk of relapse is high (e.g., Watkins, 2011). A similar tendency can be seen in research into risk of suicidal behavior, characterised by an emphasis on the (suicidal) thought content evoked by low mood and how this can be modified on an ideational level (e.g., reasons for living). However, the embodied cognition theory we offer would suggest that what is needed is not more abstraction but a more embodied processing of (suicidal, addictive) urges. How might this be tested empirically? The theory for addiction could be tested by means of a cue exposure design, in which people in remission from an addiction were allocated to either abstract or experiential processing and then exposed to addictive cues (e.g., smell of alcohol). Our prediction, i.e., increased impulsive behaviour in the abstract compared to the experiential condition, could be tested by means of tests of behavioural impulse control (e.g. a “go/no go” paradigm) or tests of attentional conflict or bias (e.g. emotional Stroop test or dot-probe; see Fox, 2010). A similar design could be used for people in remission from suicidal depression; in which the effect of suicidal cues (e.g., thoughts, images) on mood disturbance/urge to act on suicidal mood are predicted to be moderated by experiential versus abstract processing.

Conclusion Although older reviews had considered extensive evidence consistent with the embodied cognition model, in this article we have examined more recent studies of this paradigm, published since 2000, showing how they extend and confirm the earlier findings of this literature. We examined the relevance of embodiment for psychopathology, focusing particularly on the suggestion that “simulation” creates Enactment/re-enactment networks (ERNs) within a “distributed plus hub” model, which can provide a useful heuristic framework to explain the maintenance of Major Depression. In particular, we suggested that such patients could be shown to be vulnerable in three ways. First, they react to simulations in such a way that small changes in one component of the network produce re-enactment of specific problematic behavior. Second, due to attempts to avoid negative re-enactment of prior action or specific memory, they truncate the simulation and over-use abstractions (such as over-general memories) that have shortterm adaptive effects but long term maladaptive consequences, prolonging mood disturbance, impairing problemsolving, and increasing risk of onset of new episodes of depression. Third, the over-use of abstract (language-based) representations exacerbates low mood as a result of increased rumination as an attempt to problem-solve the emotion, further compounding psychopathology. In these ways, we suggest that embodied cognition theory, together with the Enactment/re-enactment networks, suggest a coherent explanation of several important processes that contribute to the onset, maintenance and recurrence of emotional disorders, in particular, depression. We reviewed experimental evidence that suggested that behavioral and emotional change might be brought about by changing the level of abstraction at which people process material. Finally, we showed how new approaches to treating psychopathology are consistent with these embodied cognition paradigms, helping those patients who do not readily respond to existing approaches.

Acknowledgements The authors are grateful to the Wellcome trust for funding the current study and to Dr. Fraser Watts, Dr. Léon Turner, Professsor David Rubin, Dr. Mark Stokes and Professor Robert Rogers for helpful comments on previous drafts. Mark Williams was supported by a Programme Grant from the Wellcome Trust (GR067797).


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Appendix A Table 4: Studies of Embodied Cognition (2000 – 2013): in perception, action, language comprehension, lesion studies and social/affective cognition. 3 Study


Manipulation

Outcome Variable

Findings

24 (14)

Estimate metric distance on a field whilst either carrying heavy backpack or not carrying anything

Metric distance

Replicated Bhalla & Profitt (1999) - see text

Sugovic & Witt (2011)

44 (18 normal weight, 16 overweight, 10 obese)

Comparison of subjects with normal weight, overweight and obese on distance judgments + report perceived BMI

Reported distance

Differential overestimation for obese subgroup, rest displayed underestimation bias. No effect of perceived body size

Taylor, Witt, & Sugovic (2011)

45 ( 27 traceurs, 18 novices)

Comparison of traceurs and novices on estimation of wall height from location from which they could jump + report perceived skill (task was to imagine jumping and climbing them + estimate skill with which they could do so)

Height estimation and perceived ability to climb the walls

Novices displayed vertical-horizontal illusion (i.e., overestimated height), traceurs did not

Comparison of 2 subjects 2 (lacked sense of cutaneous touch and movement and position with no cutaneous touch or proprioception of own body) observed videos of 12 (9) controls subjects lifting boxes (big, small) to a variety of heights and asked to 1) estimate weight of box observed lifted, then 2) judge whether the subjects lifting the box had been given correct information about the weight of the box before lifting it

Accuracy of weight estimates + expectation detection

Compared with controls, subjects were able to judge the actual weight from observed action, but were significantly less accurate in judging weight expectations compared to controls

Action-specific perception account Profitt et al. (2003)

Motor-resonance account of action and perception Bosbach et al., 2005

3

Unless otherwise specified, participants were healthy subjects


41

40 students

Discrimination between natural and manufactured objects, through either pressing the button or squeezing a cylinder

Response time

Task irrelevant size of the object affects the task relevant motor response required in the discrimination task - visual perception affects motor performance - motor priming effect.

Tucker & Ellis (2004)

Not provided

Exposure to pictures depicting objects required to respond by means of squeezing hand device with different finger constellations (i.e., mimicking power and precision)

RT

Visuomotor priming showed affordance compatibility effects

Buccino et al., 2001

12 healthy right-handed subjects , 25- 38 years of age

While in fMRI, observing videotaped actions involving a mouth, hand or foot, and contrasting these with static images of mouth, hand or foot

Blood Oxygen Level (BOLD) Dependent Response

Observation of different effectors (mouth, hands or feet) induces activation in different areas of premotor cortex and parietal lobe, consistent with its mapping to respective effectors which would be involved if the action were executed.

Ehrsson et al. (2003)

7 right-handed (1), aged from 21 to 33

Subjects were asked to either move their tongue, fingers or toes, or imagine moving them, while in fMRI

BOLD response

Imagery of different body parts activates their corresponding motor regions (compared to regions actually activated with motor movement)

Michelon et al. (2006)

12 (4)

While in fMRI, participants were asked to either move their left or right hand, prepare for moving it (for a 4.15 seconds), or, imagine moving it.

BOLD response

Both imagery of movement and motor execution are laterally organized, i.e., demonstrate similar activations for right versus left conditions.

Ruby & Decety, 2001

10 right-handed healthy male

Subjects required to either imagine themselves performing an action, or to imagine the experimenter performing the action, while in fMRI machine

BOLD response

Imagining someone else's action activates many of the areas active in the first person perspective, as expected from previous studies. However, parietal, cingulate and frontal cortices are more active in the first person perspective.

Tucker & Ellis, 2001 (Exp 1)

Psychopathology Review, In Press, 1-50 Bub et al. (2008)

32

Stroop interference task, 1) color primed with object manipulation (functional or volumetric gestures),

(Exp 1 &2)

42 RT from seeing colorobject pairing to initiate movement

Latency effect for incongruent cases. Confirmed for colorword couplings in Exp. 3and 4 as well.

RT from exposure to initiated movement

Congruency effects for all conditions.

2) for incongruent pairings, asked to respond with colorassociated gesture and not gesture afforded by object Lachmair (2011)

36 (Exp 1)

(Exp 1 and 2)

24 (Exp 2)

Bach et al. (2010)

10 (7) 16 (14) 26 (20) 15

Higuchi et al. (2012)

Zanolie et al (2012) (Exp. 1)

40

Reading nouns referring to entities implying up- or downward location, required response (movement) either congruent (or not) with location. Exp conditions also included reading silently and standing still

Primed with color-shape RT from stimulus onset to Congruency effects for color – shape leave rest keys and time couplings (e.g., red cues couplings. Seeing squared and green circle from onset of movement circles or squares to fingers back on rest movements), then imitate directly influenced keys (movement time, geometrical shapes a) gesture production, MT) directly perceived or b) facilitating gestures of implied by unrelated the same shape as semantic judgments of displayed on the object words; signalled by screen. Seen shapes gesturing either a circle or influenced both RT a square with both hands and MT in front of their body 1) Observe guitar playing and either imitate (physical practice, PP) or imagine imitating the chords (observational practice, OP)

Both: Cortical activation

PP led to activation in dorsolateral prefrontal cortex and frontoparietal mirror circuit (FPMC) + connectivity left prefrontal cortex and FPMC

1) Rating valence of words (priming power and powerlessness, respectively). Categorizing pictures of people according to the same categories -> decide whether stimuli (presented in either upward or downward location on screen) is present or not

RT for target letter

Congruence effects for spatial position and perceived power (i.e., high up on visual field + powerful)

Psychopathology Review, In Press, 1-50 Lakens, Schneider, Jostmann, & Schubert, 2011

Boot & Pecher, 2010

43

41 (23)

Subjects performed two key press test of Stroop color interference task. Response keys were either located far apart or together.

RT

Distance between response keys moderates reaction time - keeping hand apart may facilitate cognitive process of categorization

30

Participants were presented with 18 color pairs. Nine were of different hues of the same color, and nine were of different colors. Participants had to judge if two colors were similar or different

Reaction time.

Participants were able to respond faster when similar colors were presented close, as well as when dissimilar colors were presented far.

Motor simulation and language comprehension 24 (13) right-handed

Discrimination between two phonemes (continuum from “ba” to “da”), with TMS disrupting the area of motor cortex responsible for lip movement.

Correct discrimination between phonemes (same or different)

Phonemes which are pronounced using lip movement were discriminated with more difficulty post TMS application

12 (5)

Lexical decision task (linguistic stimuli consisting of words related to arm or leg + pseudo-words); make brisk lip movement when recognizing meaningful word, whilst TMS of hand and leg areas of left motor cortex

RT

Somatotopically differential latency effects (i.e., RT for arm related words were briefer than for leg related words after arm area TMS)

Buccino et al. (2005)

8

1) Listen to action sentences (implying either foot or arm movement) and abstract content sentences, whilst TMS of hand and foot area cortex, 2) respond with foot or arm movement to either of three sentence categories

1) MEPs of arm and leg, 2) RT from auditory stimulus to movement onset

1) Effector-specific decreases in MEPs, 2) ditto for RT

Labruna et al. (2011)

19 (10)

Memory recall test of action and non-action words presented either visually or auditorily whilst TMS of hand area of left motor cortex

MEP of right hand area

Modality effects; MEPs > for action words than non-words in visual modality, no diff for auditory condition

Willems et al. (2011)

18 (11)

Lexical decision task (including manual and non-manual words as well as non-words and having to decide whether English word) whilst TMS to left and right premotor cortex

RT between exposure and decision

Congruency effects between premotor cortex activation and word category (processing of manual words facilitated by motor stimulation)

Mottonen & Watkins (2009)

Pulvermuller et al. (2005)


44 Frequency of MEP in prefrontal cortex

Differential motor activation following nouns referring to tools > natural objects (e.g., action > nonaction)

Gough et al. (2012)

15 (10)

Lexical decision task, exposed to noun referring to artifacts (graspable & non—graspable) and natural objects (ditto) whilst TMS of hand area of left motor cortex, decide by pushing yes/no button whether noun refers to natural object

Wallentin et al. (2011)

26 (9)

Listening to fairy tale whilst in MRI, + various tests to check attention.

Cacciari et al. (2011)

9

Reading sentences (4 motion categories: literal, non-literal, idiomatic and fictive) whilst TMS to left motor cortex. All action sentences referred to leg motions

MEP from leg muscle area (i.e., right side from GCN and tibilais anterior (TA)

Action sentences differentially activated motor cortex, MEP: literal>fictive>metaph orical. No activation for idiomatic sentences.

Pecher et al. (2004)

106

Subjects (native Dutch speakers) were presented with 64 concepts, each with three properties. One of the properties was a sensory modality. Subjects were asked to respond if the property was true or false for the concept.

RT

Previous presentation of the property from the same modality for a concept facilitated verification of a different property from the same modality switching costs were detected.

81 (73)

Subjects were presented with 144 concept-property associations (one third positive, one third negative and one third neutral). Each property was from a certain sensory modality. Subjects were asked to respond if the property was true or false for the concept.

RT

Previous presentation of the property from the same modality for a concept facilitated verification of a different property from the same modality. Furthermore, affect modality also demonstrated switching costs, indicating that affect might be simulated too.

42

Experiment 2: 80 adjective-noun compounds (half of which are novel, e.g., shimmering tuna), with modality relevant adjectives were presented. Participants were asked to provide an interpretation as fast as they could.

RT

Modality switching costs emerge also during concept creation, indicating that even such abstract tasks are perceptually grounded.

Vermeulen, Niedenthal, & Luminet (2007)

Connell & Lynott (2011)

Cortical activation for Differential activation sequences of action verbs of left posterior middle (identified by independent temporal gyrus raters) (LPMT) for sections involving action verbs


45

169

Stimuli consisted of 200 sensible sentences referring to ten emotional and ten non-emotional states, with either internal or external focus. Participants had to judge the sensibility of the sentences (there were 400 non-sensible sentences).

RT

Internal or external focus demonstrates switching costs, indicating that external and internal sentences are understood through simulation in different systems.

Mottonen & Watkins (2009)

30 (right-handed)

Identification task (identifying auditory presented phonemes by pressing button; twochoice task) + discrimination task (decide whether lip articulated phonemes vs. syllables not articulated by lips (e.g., /pa/-/ta/) as well as various phonemes articulated by tongue only (e.g., /da/-/ga/) sounded different) whilst TMS to motor cortex controlling lip and hand movement

Categorical perception (CP) of place of articulation continuum (i.e., lip- and tonguearticulated phonemes)

Identification task: Disruption of lip (but not hand) movement decreased capacity to differentiate lip vs. tongue-articulated phonemes. Discrimination task: Disruption of lip movement decreased capacity to differentiate lip vs. tongue-articulated phonemes but not capacity to differentiate various tongue-articulated phonemes (ga)

Zwaan, Stanfield, & Yaxley (2002)

51 (Study 1)

Sentence-picture verification task in which subjects were first exposed to experimental sentences describing objects with different implied shape of the same object (e.g., eagle in the sky vs. eagle with wings folded in) + filler sentences, followed by exposure to pictures (depicted/not depicted the mentioned object, matched/mismatched the shape implied by the sentence) – > decide whether objects in picture had been mentioned in the previous sentence by pressing designated ‘yes’ and ‘no’ keys on keyboard. The task did not require awareness of objects’ orientation

RT and accuracy

Significant mismatch effect on response latency, i.e., participants verified pictures that matched the implied orientation faster than pictures that mismatched. Findings support notion of activation of perceptual symbols including information about shape in language comprehension

Oosterwijk et al. (2012)

Psychopathology Review, In Press, 1-50 Zwaan & Pecher (2012)

189 (102) (Study 1a) 199 (114) (Study 2a) 188 (117) (Study 2b)

Lexical task (to familiarize with responding to visual stimuli) - > Sentenceverification task (exposed to sentences describing objects with implied horizontal or vertical orientation (+filler sentences)+ pictures depicting the objects with h and v orientation. Subjects then completed imagery questionnaire reassessing vividness of mental picture

46 RT and accuracy

Longer RT for reacting to same object If cued with picture depicting object in different orientation 2a and 2b) replicated the match/mismatch effect reported by Zwaan, Stanfield & Yaxley (2002)

Procedure identical to Zwaan, Stanfield & Yaxley (2002) Lesion studies Capitani et al. (2009)

28 (18 left, 8 right, 2 bilateral PCA)

van Elk, van Schie, Zwaan, & Bekkering, 2010

Performance across three Category dissociation biological and three with part of subgroup artifacts categories with left PCA damage (plant life impairment > animal categories)

Semantic judgment tasks RT for semantically strong and weak pairs whilst TMS induced lesion – identifying target word associated with cue + letter matching task

Latency effects for both areas for executively demanding semantic decisions (weak pairs), not for low sem. control condition.

2; left & right hemispherectomy (LH & RH)

Word + picture generation task (stimuli ref to objects used by arm or hand) – naming and indicate use

RT (vocalization RT – voice onset)

Semantic generation: Differential dissociation for leg stimuli only (RH outperformed LH). Picture naming: RH impaired on leg stimuli, LH close to control.

24 (20) right-handed native speakers

Stimulus was 136 sentences of either human or animal actions, with same verbs presented in both lists. Motor activation to these presentations was monitored through EEG.

RT

Motoric activation precedes and enables semantic integration through supporting its retrieval and integration

Whitney et al (2011)

Esopenko et al. (2011)

Semantic task (picture naming, pointing to pictures, memory questionnaire + visual reality decision test)

Psychopathology Review, In Press, 1-50 Gianelli, Farne, Salemme, Jeannerod, & Roy, 2011

Riddoch et al. (2003)

47

34, right handed native speakers.

Stimuli are a number of sentences which subjects are asked to perform. Sentences were presented in the third person perspective (Experiment 3), but, crucially, disembodied actor was given a known spatial location to facilitate motoric processing.

Enacting a directional movement based on the sentence

Ability to enact a movement from a third person perspective sentence description is contingent on knowing a location of the third person so they can imagine embodying their space.

5 (all with lesions)

Patients’ lesions created visual extinction, a phenomenon in which presentation of two stimuli simultaneously makes one of them imperceptible.

Number of stimuli perceived (i.e., one or both)

When two stimuli were presented as ready for action, they were more often perceived by the subjects, indicating that action grouping is one way in which brain primes stimuli together.

Social cognition and embodiment Kawakami et al. (2002)

60 (37)

RT from exposure of word Latency effect on nonCategorize series of to lexical decision stereotypic words for photographs according to subjects primed with elderly or not (priming) + elderly stereotype and lexical decision task facilitated RT for (word? yes/no) stereotypic words

11 (6)

Elderly stereotype (cf Bargh et al.) primed Task: evaluating head-up displays in driving simulator, completing scrambled sentence tasks whilst waiting at stop lights

Max driving speed + total Convergence effects driving time of priming on behavior (lower max driving speed + longer total driving time for subjects primed with elderly stereotype

54 (Exp. 1)

Firming muscles whilst holding pen and evaluating/sustain on various parameters (aversive charity appeal, physical pain, drinking vinegar (aka health tonic), shopping snacks, choosing food after exposure to selfregulation scenario/narrative

Money donation/time enduring pain, volume of drink, food choice in shopping and selfregulation task + selfreported perceived goals in each area

Deliberate muscle tension increased willpower across all parameters (e.g., withstand pain, resist eating unhealthy food etc.)

Startle reflex compared for subjects in motoric withdrawal (arm extension) or approach condition (arm flexion)

Startle reflex

Startle reflex larger for subjects in withdrawal condition compared with subjects in the approach condition

Exp. 1

Branaghan & Gray (2010)

Hung & Labroo (2011)

47 (Exp. 2) 91 (Exp. 3 66 (Exp. 4) 95 (Exp. 5)

Thibodeau (2011)

(not available)


48

Duguid & Goncalo (2012)

68 (35)

Participants were asked to recall either an incident in which they had power over another individual, or an incident in which they had low power.

Own height estimate in relation to pole twenty inches taller

Participants primed with the high power condition judged the pole to be shorter relative to them than low power and control participants.

Horstmann & Ansorge (2011, Exp 1)

24 (12)

Imitate facial expressions seen on screen or vertical head tilts whilst exposed to various tones (e.g., high, low)

RT for imitation

Cross-modal compatibility effect for facial expression (i.e., angry imitated faster for low > high tones, happy faster for high > low) and head tilts (i.e., upward imitated faster for high > low tones, opp. for downward).

Natanzon & Ferguson (2012)

(not available)

Forward priming; exposure to simple visual cues of forward movement

RT negative adjectives – RT to positive adjectives

Forward primed displayed higher motivation to notion of achievement + outperformed controls on word puzzles despite no conscious achievement motivation

Williams & Bargh (2008)

41

Those who held the Personality rating of an Two between subjects priming conditions - either individual based on a very warm coffee cup rated the person as brief description. holding a hot or cold cup significantly warmer of coffee. than those who held the cold coffee cup

Psychopathology Review, In Press, 1-50 Ackerman, Nocera, & Bargh (2010)

54 (Study 1)

Evaluate job candidate by reviewing resumes on either light or heavy clipboards

43 (Study 2) Complete social survey on social issues widely acknowledged as important+ idiosyncratic/less important issues , provided on heavy and light clipboard 64 (Study 3)

Complete simple puzzle consisting of rough or smooth pieces. Read transcript of socially ambiguous exchange and rate dialogue in terms of difficulty/harshness + familiarity between parts involved.

Miles, Nind & Macrae (2010)

Friedman & Forster (2000)

20 (11)

Participants were fitted with a movement sensor, blindfolded and asked to recall their life four years in the past, and to imagine their life four years in the future.

32 right handed

In Experiment 2, participants were required to complete the Snowy picture test

49

Participants in heavy clipboard condition rated the candidate as more qualified overall + perceived of candidate as more interested in the position compared to participants with light Response to important clipboard social issues by clipboard Men in heavy condition condition allocate more money to important social issues compared to light condition. No effect of clipboard condition found for women. No effect of Ratings of harshness and clipboard familiarity by texture manipulation on condition idiosyncratic/less important issues. Rating of qualifications + candidate’s interest in position

Rough texture condition associated with higher levels of difficulty/harshness reported compared to smooth condition. No effect on rating of familiarity. Postural sway

Retrospective thinking resulted in backward tilted postural sway, and prospective thinking in forward inclined postural sway.

Snowy pictures test

RT to identify picture shorter in arm flexion (approach) condition

Success at solving a creative task

More creative problem solving in walk freely condition

Participants either flexed or extended their arms while completing the task.

Participants were asked to think about a problem requiring a creative solution (droodle task and a lego task). They were asked to walk either in rectangular pattern, or to freely walk in the room.

Psychopathology Review, In Press, 1-50 Friedman & Forster (2001)

90

Chandler, Reinhard, & Schwarz (2012)

50

Participants were asked to complete either a maze where reward was sought (cheese – promotion condition), or a maze where harm was avoided (owl- prevention condition).

Snowy picture test success

Participants in the promotion cues experiment solved significantly more tasks than participants in the prevention cue condition.

Presented with face-up copy of potentially familiar book (The Catcher in the Rye)

Rate importance on American literature from 1-10 + indicate whether had read it or not

Ratings of importance were higher among participants who had read the book compared to those who had not (no significant effect of weight), whereas among participants who had read it ratings were higher for the heavy compared to the light condition.

RT - determine if a word is a flower or an insect

Participants prone to negative affect were faster to attend to lower regions of the screen

Two conditions: heavy or normal weight copy

Meier & Robinson (2006)

24 (16)

In Experiment 1, visual targets were presented alternatively at either top or bottom of the screen, followed by a centralized stimuli. Participants’ level of neuroticism was measured.