Dynamic Cognitive Characteristics of Emotional Conflict in

Individuals with Subthreshold Depression : An Event-Related

Potential Study

Weizhou Wanga, Qi Xieb,Lulu Zhangc,Jingyi Zhouc,Shuang Huc*

a
Hebei University of Economics and Trade, Shijiazhuang, China
b
Hunan Industrial Vocational Technology College, Changsha, China
c
College of Health, Shandong University of Traditional Chinese Medicine, Jinan,
China
*
Corresponding author at: 1No. 4655, University Road, Changqing District, Jinan
City, Shandong Province 250300, China.
E-mail address: [email protected]
Dynamic Cognitive Characteristics of Emotional Conflict in

Individuals with Subthreshold Depression : An Event-Related

Potential Study

Subthreshold Depression (SubD) significantly impacts subjective well-being

and psychosocial functioning, serving as a precursor to Major Depressive

Disorder (MDD). Deficits in emotional conflict resolution are characteristic of

mood disorders. This study employed event-related potential (ERP) recordings

to validate impairments in cognitive processing mechanisms for emotional

conflict in SubD patients.

Methods: Healthy Control (HC) and SubD groups, each comprising 32

subjects, completed the word-face Stroop paradigm, with ERP amplitudes and

latencies recorded.

Results: The SubD group displayed lower accuracy and prolonged response

times in both "consistent stimulus" and "inconsistent stimulus" conditions.

Across stimulus conditions, the SubD group exhibited an increased N2

amplitude in the prefrontal mid-lobe region. Furthermore, in the SubD group,

the N450 amplitude was greater in the prefrontal middle region for

"incongruent stimulus minus congruent stimulus," while the conflict SP

amplitude was smaller in the parieto-occipital region for the same contrast.

Conclusions: Behavioral and neural evidence suggests dynamic cognitive

deficits in emotional conflict processing among individuals with SubD. This

involves heightened sensitivity to early processing of emotional stimuli and

 enhanced detection of emotional conflict, coupled with delayed adaptation and

response options following emotional conflict resolution.

Keywords:subthreshold depression, emotional conflict, N2, N450, conflict SP

Introduction

Major Depressive Disorder (MDD) stands as a formidable global health challenge,

significantly contributing to disability and mortality worldwide (Ferrari et al., 2013).

Unraveling the factors that elevate the risk of MDD is essential for effective

intervention and prevention strategies. Subthreshold depression (SubD), sharing

symptomatic similarities with MDD but to a lesser extent and without meeting

diagnostic criteria (Dai Q et al., 2012; Hayasaka Y et al., 2015), has emerged as a

rising burden on healthcare services, surpassing MDD in its impact on patients'

quality of life (Lee, Y. et al., 2019; Tuithof, M. et al., 2018). Particularly vulnerable

among adolescents (Bertha and Balazs, 2013), SubD's prevalence is evident among

Chinese university students (32%) (Jiang et al., 2019) and European college students

(23%-39%) (Mikolajczyk et al., 2008). SubD acts as a risk factor for depression, with

a 10-25% risk of progression to MDD within 1-3 years (Cuijpers and Smit, 2004).

Consequently, SubD research provides valuable insights into the pathophysiology of

MDD and aids in the development of preventive strategies.

Emotional Processing Mechanisms in MDD

MDD arises from abnormalities in emotional processing mechanisms, resulting in

deficits in emotional neurocognitive processes (Disner SG et al., 2011). Individuals

with MDD exhibit selective perception and evaluation of emotional information,

leading to abnormally heightened negative emotions and reduced positive emotions

(Jones, E. B. and Sharpe, L., 2017). Dysregulation in conflict monitoring in MDD,

observed in competitive tasks related to response options (Ottowitz WE et al., 2002;

Epp AM et al., 2012), may serve as a marker of executive dysfunction. Beyond

cognitive aspects, conflict monitoring extends to emotionally conflicting stimuli in the

environment, interfering with ongoing behaviors (LeDoux JE, 2000; Tipples J and

Sharma D, 2000).

Emotional Conflict and Mood Disorders

Emotional conflict, originating from cognitive conflict, involves the interference of

unrelated stimuli with ongoing cognitive tasks (Etkin A et al., 2006). Individuals with

certain mood disorders, such as depression and anxiety disorders, demonstrate an

inability to resolve and adapt to emotional conflicts (Williams JM, 1996; Xue S,

2017). Compared to healthy controls, individuals with depression exhibit longer

reaction times and lower accuracy in naming the colors of sad words in an emotional

Stroop paradigm (Ottowitz WE et al., 2002). Defective emotional conflict processes

represent an underlying deficit in depressed individuals (Anderson ND et al., 2007),

underscoring the importance of controlling emotional conflict for both normal

function and mood disorder treatment.

Methodological Approach

Most prior investigations of emotional conflict have employed the emotional Stroop

paradigm, but this paradigm fails to elicit genuine emotional conflict between the

emotional content of words and color names (Algom et al., 2004). The word-face
Stroop paradigm, an adaptation of the emotional Stroop paradigm, serves as a primary

approach for studying emotional conflict, allowing for a direct assessment. In this

paradigm, emotional words are presented on emotionally colored faces, and subjects

are tasked with evaluating the emotional value of the face or word (Stenberg et al.,

1998; Kavcic & Clarke, 2000).

Previous studies have shown that the event-related potential (ERP) technique

is used widely. It is a technique with high temporal resolution that compensates for

the shortcomings of other methods in cognitive neuroscience and allows us to better

understand cognitive processes.Utilizing the event-related potential (ERP) technique,

widely employed for its high temporal resolution, previous studies employing the

word-face Stroop paradigm revealed that incongruent stimuli evoked a more negative

N2 component approximately 200-300ms post-presentation. The N2 amplitude in the

frontal central region appears to be associated with emotion control and conflict

detection (Thomas et al., 2007; van Hooff et al., 2008). Furthermore, word-face

incongruent stimuli produced a more negative N450 component in the central frontal

region 300-500ms after presentation, indicating conflict detection in the Stroop task

(Coderre, Conklin, & van Heuven, 2011). The left midline region exhibited the

greatest amplitude for early N450 (350-450ms), while the central midline region

showed the highest amplitude for late N450 (450-500ms). This suggests that early and

late components of N450 may be implicated in distinct stages of cognitive control

(Taake et al., 2009; Wei et al., 2010).Additionally, conflict slow potential (SP), a

positive component sensitive to conflict, emerges over parietal areas during the 700-
800ms time window. The SP is commonly associated with conflict resolution

(DePisapia & Braver, 2006), response selection (Chen et al., 2011), and monitoring

(Larson et al., 2009).

Research Gap in SubD

While research on emotional conflict in depressed patients is comprehensive, less

attention has been given to individuals with SubD. Investigating emotional conflict in

SubD patients is crucial for understanding mechanisms and informing diagnosis and

treatment.

Hypotheses

Behaviorally, we anticipate the SubD group to exhibit prolonged reaction times (RT)

and reduced accuracy (ACC) compared to the Healthy Control (HC) group.

Neurologically, we hypothesize abnormal neurophysiological indicators in SubD

patients, including an overall increase in N2, N450, and SP amplitude levels during

word-face dysregulation conditions. These alterations signify impaired neural

processes underlying cognitive control deficits in SubD.

In summary, our study aims to bridge the research gap by investigating the dynamic

cognitive processes in SubD patients during an emotional conflict task, utilizing ERP

technology and the word-face Stroop paradigm. The anticipated findings may

contribute significantly to understanding the neural underpinnings of SubD and

inform potential interventions for MDD prevention.

Materials and Methods

Participants
64 undergraduate students (42 women, 22 men) were recruited from the Shandong

University of traditional Chinese medicine ， Jinan ， China ， which through

advertisements and grouped according to their scores on the Center for

Epidemiological Survey. Depression Scale (CES-D) (Radloff LS, 1977)and the

Hamilton Depression Scale-17 (Hamilton M, 1967). Both scales had Chinese

adaptations and had been widely used. The SubD group were screened using a cutoff

score of≥16 on the CES-D according to previously reported literature (Buntrock C et

al., 2017), which is the usual way of indicating “having depressive symptoms” in

CES-D. The Hamilton Depression Scale-17 was then used to confirm SD and exclude

clinical depression using a score range of between 7 and 17 indicating a mild

depression (0~6 ： no depression, 7~17 ： mild depression ， 18~24 ： moderate

depression， above 25： severe depression) (Ballesteros J et al., 2007). The Hamilton

Depression Scale-17 was performed by at least two assessors, at least one of whom

was qualified as a national psychological consultant. All assessors had received

training in the assessment's administration. The inclusion criteria for the HC group

were CES-D score of ＜ 16. Exclusion Criteria for both SubD and HC participants

were (1) did not fulfill the SCID diagnostic criteria for MDD; (2) had no current

bipolar disorder, panic disorder or schizophrenia; (3) had no concurrent

psychotherapy and psychotropic medication; and (4)not pregnant and currently not in

their menstrual period.

All participants were right-handed, and at the time of the experiment, the SubD

group was not receiving medication or was entering the experiment 1 month after
weaning from medication. Prior to participating in the experiment, subjects were

carefully informed of the purpose of the experiment and the procedure and signed an

informed consent form. The study was conducted in accordance with the Declaration

of Helsinki as revised in 1989. The subjects were compensated after completing all

study procedures.The study approval (2022-087-KY) was given by the Institutional

Review Board (IRB) of Affiliated Hospital of Shandong University of Traditional

Chinese Medicine.

Experimental material

The stimulus materials comprised both happy-face and sad-face photographs of

people. All photographs were selected from the Native Chinese Affective Picture

System (Lu B et al., 2005), which has been deemed to be appropriate for use with the

Chinese population. We selected 20 happy-face and 20 sad-face photographs

according to a 1:1 sex ratio and used red font for the words “ 高兴 (‘ gaoxing’ means

happy)” or “ 悲伤 (‘beishang’ means sad)” over the central portion of the faces in the

photographs. The text appears on the nose area of the face and the font size is

approximately 1cm x 1cm, an example of which is shown in Figure 1. In the task,

there are two conditions (congruent, incongruent), congruent in the sense that the

facial expression in the picture agrees with the meaning of the word, and incongruent

in the sense that the facial expression does not agree with the meaning of the word

The image was eventually rendered on a 17 inch CRT computer screen, measuring

5cm by 7cm.

Experimental Paradigm
The word-face Stroop paradigm was used in this study. For the specific experimental

design, refer to the study by Song Xue et al (Xue, S et al., 2017). The entire

experiment comprised one practical trial and four blocks, with each block consisting

of 80 trials. After completing a block, the participants were provided 1-2 minutes of

rest. When the experiment started, one photograph containing an emotional face and

an emotional word was shown in the middle of the screen for 1500ms. The stimulus

time interval was between 3000ms and 5000ms (average: 4000ms), and the central

screen displayed a “+” between the stimuli. (Figure 1.)

For the congruent and incongruent tasks in this study, the experimenters asked

the participants to determine whether the face was sad or happy and to press a button

in response as soon as possible. The participants were instructed to press the “S”

button with their left-hand finger when the face appeared sad and the “K” button with
their right-hand finger when the face appeared happy. The order of the stimuli was

pseudo-random, and all experimental stimuli, as well as the sex of the faces, were

balanced. The picture presentation was ended once the participant pressed the correct

button or after 1500ms had elapsed. A blank screen was then presented for 800 to

1200ms. In total ， 160 trials were recorded for each type of stimuli. The whole

experiment took about 30 minutes.

The experiment was conducted in a quiet environment, using two computers, one

for presenting the stimuli and one for recording the EEG data. During the experiment,

subjects were asked to minimise body movements, especially head and facial

movements. The subjects were asked to look at the screen with their eyes, their faces

75 cm away from the screen and their horizontal and vertical viewing angles less than

68 degrees. In order to ensure that the subjects were sufficiently familiar with the

whole procedure, a 20-trial pretest was conducted before the formal start of the

experiment, and the pre-test procedure was the same as in the formal experiment.

EEG Recording

In this experiment, a 64-channel electrode cap is used to continuously record EEG.

The electrode cap is distributed according to the international 10/20 system, and the

sampling rate is 512Hz. After the original signal is amplified, a bandpass filter (0.01-

100Hz) is applied. EEG data were collected using a Biosemi (Biosemi, UvA, NL)

ActiveTwo Data Conversion Box. Impedances were kept below 5 kΩ throughout the

recording. The preprocessing and analysis of the EEG data was performed in Matlab

(version R2014a; MathWorks, Inc, MA, USA) using the EEGlab toolbox (Delorme
and Makeig, 2004), the ERPlab toolbox (Lopez-Calderon and Luck, 2014).

The electrodes were referenced to the CMS (Figure 2.) during acquisition and the

REST was used as the offline reference, with the study shows that it is more

appropriate to use REST reference scheme settings in facial recognition experiments

(Wang, Y et al., 2019). Electrodes were placed above and below the left eye and at the

outside of the left and the right canthi to measure the electrooculogram. Ocular

artefacts were corrected using the independent component analysis (ICA) procedure

in the EEGlab toolbox (Delorme and Makeig,2004). The offline high-pass filter is set

to 0.1 and the low-pass filter is set to 35 Hz, with a band-pass filter to improve the

signal-to-noise ratio. The data 200 ms before the start of the stimulus is used for the

baseline correction of the ERP. The continuous EEG is divided into the period starting

-200 ms before the start of the stimulus and ending at 1000 ms after the start of the

stimulus. Tests exceeding ±100μV are excluded from further analysis. Epochs

containing artefacts were rejected prior to averaging. The average number of accepted

trials was 145 (SD=6) in the word-face emotion consistency condition, 151 (SD=4) in

the word-face emotion inconsistency condition.

 To quantify the ERP data, we calculated mean amplitudes for each condition in

150~250ms, 350~450ms and 700~800ms time windows. We chose the above time

window based on previous studies and visual inspection of ERP waveforms. We

included the 150~250ms time window to capture the N2 effect, the 350~450ms to

capture the N450 effect, and the 700~800ms time window to capture the SP effect.

Based on previous research and observation of the difference wave topography. In

this study, N2 and N450 in the central prefrontal region and SP in the posterior central

region of the parieto-occipital lobe were selected for analysis. Three electrode sites,

FZ, FPZ and FCZ, were selected for analysis with average wave amplitudes of N2 and

N450 in the central prefrontal region, and three electrode sites, PZ, POZ and OZ, were

selected for analysis with average wave amplitudes of SP in the posterior central

parieto-occipital region.Please see Figure 3 for details.

Statistical analysis
Descriptive data were presented as mean±SD unless otherwise specified. T-test

and X2 test were used to compare the demographic data and depression scales (CES-

D and Hamilton Depression Scale-17) between SubD participants and HCs.

The E-prime procedure was used to record subject reaction time (RT)of correctly

and the accuracy of responses (ACC) spss 22 to analyse these behavioural data. A

two factor repeated measure ANOVA with RT and ACC as dependent variables,

respectively, was used to examine the group (SubD vs HC) as the between-subject

factor, and word-face emotional coherence (congruent vs incongruent) as the within-

subject factor. The significance level was 0.05.

A three-factor repeated measure ANOVA was used to examine the latencies and

amplitudes of N2, N450 and SP, with the group (SubD vs HC) as the between-subject
factor, and word-face consistency (congruent vs incongruent) ×electrode point (N2

(FZ, FPZ, FCZ); N450（FZ, FPZ, FCZ）;SP（PZ, POZ, OZ) as the within-subject

factor. The normality of data was checked before applying parametric tests. The

Greenhouse–Geisser correction was used to correct repeated measure ANOVA that

violated the sphericity assumption, and the Bonferroni correction was applied to all

post hoc pairwise comparisons. The significance level was 0.05.

RESULTS
Demographic Characteristics
Demographic data for subjects in the HC group and SubD group are shown in Table

1. The mean age was 19.813±0.859 years in the SubD group and 19.563±0.759 years

in the HC group. The two groups were no statistically significant differences on the

age(t=-1.233; P=0.222), gender(X2=0.549; P=0.443) and education(t=0.151;

P=0.880) dimensions, showing that the two groups were well matched. In contrast, as

an important difference in our setting, CES-D scores are significantly different

between HC group.and SubD group (t=22.504; P＜0.001).

TABLE 1. Group Characteristics (Mean±SD）

SD HC
Variable （n=32） （n=32） Statistics P
Gender
10/22 12/20 χ2 =0.549 0.443
(male/female)
Age
19.813±0.859 19.563±0.759 t=-1.233 0.222
(years)
Education
10.169±0.941 10.203±0.879 t=0.151 0.880
(years)
CES-D 28.173±9.863 8.168±3.905 t=22.504 ＜0.001
HAMD-17 10.253±3.393 —‡ —* —*
‡: The HAMD-17 was not administered in the HC after screening with the CES-D.
*: Group comparisons are not required.
CES-D: Center for Epidemiological Survey, Depression Scale.
HAMD-17: Hamilton Depression Scale-17; HC, healthy control.

Analysis of Behavioral Data

The mean and SD of RT and ACC for each condition are shown in Table 2. First,

RT was used as a dependent variable to analyze the repeated measures of ANOVA for

the group (SubD vs HC) × word-face emotion consistency (congruent vs

incongruent). The results showed that the main effect of group was significant (F

(1,62) =17.431, P<0.001), and the main effect of word-face emotion consistency was

significant (F (1,62) =67.937, P<0.001), and the interaction between them was

significant (F (1,62) =25.432, P<0.001)，further simple analysis of the effect shows

that the SubD group’s RT under the condition of word-face emotion inconsistency

was significantly greater than the word-face emotion consistency (F (1,62) =8.242,
P<0.001), and the HC group’s RT under the condition of emotional inconsistency is

also significantly greater than the word-face emotional agreement F (1,62) =3.312,

P<0.001).

Then, ACC was used as a dependent variable to analyze the repeated measures of

ANOVA for the group (SubD vs HC ） × word-face emotion consistency

(congruent vs incongruent). The results showed that the main effect of group was

significant (F (1,62) = 5.690, p<0.001), and the main effect of word-face emotion

consistency was significant (F (1,62) = 96.916, p < 0.001), other effects were not

significant. After pair-wise comparison, it was found that the ACC of SubD group

was lower than that of HC group, and under consistent was higher than that under

inconsistent.

TABLE 2. Behavioral data comparison between SD and HC (Mean±SD)

Task Group Mean RTs (ms) Mean ACC

SubD 747.093±16.122 0.901±0.016

Congruent
HC 659.269±8.658 0.950±0.008

SubD 797.560±20.305 0.812±0.022

Incongruent
HC 712.149±17.865 0.869±0.014

Abbreviations: SubD, Subthreshold depression; HC, Healthy control; RT, response time; ACC,
accuracy score.

ERP Results
N2
The latencies and amplitudes of N2 were statistically analyzed. Please see Table 3 and

Figure 4 for details. The ANOVA on N2 amplitudes showed a main effect of

electrode site (FPZ=-0.609μV; FZ=-2.787μV; FCZ=-0.803μV; F(2,62)=39.227,

P<0.001)with the largest amplitudes in the FZ and the smallest amplitudes in the FPZ.

There was a main effect of group (HC=-0.455μV; SubD=-2.344μV; F(1,31)=5.819,

P=0.022<0.05) ， with smaller amplitudes in the HC group than in the SubD group.

Between-group comparisons on N2 amplitudes showed the SubD group had smaller

amplitudes than the HC group in each type of word-face emotion consistency stimuli.

(congruent ： P=0.047 ＜ 0.05 ， incongruent ： P=0.012 ＜ 0.05). There was no

interaction between group and word-face consistency (F (1,31) =3.227, P=0.082).

The ANOVA on N2 latencies showed a main effect of electrode site

(FPZ=220.276ms; FZ=220.429ms; FCZ=217.240ms; F(2,62)=4.221, P=0.021<0.05),

with smaller latencies in the FCZ compared with both the FPZ and the FZ. There was

no main effect of group (HC=219.523ms ； SubD=219.106ms; F(1,31)=0.074,

P=0.787). No interaction between group and word-face consistency (F(2,62)=0.707,

P=0.497).

TABLE 3. Description for N2 Amplitude (μV) and Latency (ms) (Mean±SD)

Task Group P7 O1 OZ

Amplitude -3.567±0.567 -1.532±0.540 -1.732±0.459

SD
Latency 218.567±2.958 220.520±3.145 219.788±3.294
Congruent
Amplitude -2.107±0.638 0.213±0.724 -0.001±.756
HC
Latency 223.145±1.933 221.436±2.829 216.675±3.378
Incongruent SD Amplitude -3.691±0.548 -1.702±0.475 -1.839±0.426
 Latency 219.422±2.971 220.032±3.181 216.309±3.516
Amplitude -1.781±0.623 0.585±0.790 0.362±0.781
HC
Latency 220.581±2.584 219.116±3.277 216.187±3.422

N450

The amplitudes and latencies of N450 were statistically analyzed. Please see Table 4

and Figure 4 for details. The ANOVA on N450 amplitudes showed a main effect of

electrode site （ FZ=-1.511μV; FCZ=0.350μV; FPZ=0.219μV; F(2,62)=21.783,

P<0.001 ） with the largest amplitudes in the FZ and the smallest amplitudes in the

FCZ. There was a main effect of group (HC=0.694μV ； SubD=-1.322μV;

 F(1,31)=8.136, P=0.008<0.05)，with smaller amplitudes in the HC group than in the

SubD group. There was a main effect of word-face emotion consistency (congruent=-

0.112μV; incongruent=-0.517μV; F (1,31) =20.615, P<0.001), and it was found that

there was a trend interaction between group and word-face emotion consistency (F

(1,31) =5.051, P=0.032<0.05), further analysis of the simple effect showed that the

HC group had a smaller differential wave of N450 induced by discordant and

consistent conditions than the SubD group (differential wave of HC group=-0.210μV;

differential wave of SubD group=-0.600μV; P=0.001＜0.001).

The ANOVA on N450 latencies showed a main effect of group (HC=409.638ms;

SubD=403.107ms; F(1,31)=6.799; P=0.014 ＜ 0.05), with longer latencies in the

HC group than in the SubD group. There was no main effect of word-face emotion

consistency (congruent=406.281ms; incongruent=406.464ms; F(1,31)=0.016,

P=0.899). No interaction between group and word-face consistency

(F(1,31)=1.818,P=0.187).

TABLE 4. Description for N450 Amplitude (μV) and Latency (ms) (Mean±SD)

Task Group P7 O1 OZ

Amplitude -2.248±0.600 -0.416±0.487 -0.403±0.505

SD
Latency 408.142±3.027 402.649±3.257 401.855±3.580
Congruent
Amplitude -0.185±0.464 1.535±0.666 1.047±0.637
HC
Latency 409.790±2.884 405.945±2.695 409.302±2.398
Amplitude -2.580±0.606 -0.661±0.449 -0.750±0.478
SD
Latency 402.344±3.411 402.100±2.946 401.550±3.179
Incongruent
Amplitude -0.720±0.465 0.792±0.652 1.695±0.702
HC
Latency 411.621±2.902 408.997±3.009 412.171±2.838
SP

The amplitudes and latencies of SP were statistically analyzed. Please see Table 5 and

Figure 4 for details. The ANOVA on SP amplitudes showed a main effect of electrode

site（PZ=1.523μV; POZ=-0.270μV; OZ=0.651μV; F (2,62) =25.201, P<0.001); with

the largest amplitudes in the PZ and the smallest amplitudes in the POZ. There was a

main effect of group (HC=0.838μV ； SubD=0.431μV; F(1,31)=4.152,

P=0.040<0.05), with smaller amplitudes in the SubD group than in the HC group.

There was a main effect of word-face consistency (congruent=0.162μV;

incongruent=1.107μV; F (1,31) =36.627, P<0.001), and it was found that there was a

trend interaction between group and word-face consistency (F (1,31) =12.283,

P<0.001), further analysis of the simple effect showed that the SubD group had a

smaller differential wave of SP induced by discordant and consistent conditions than

the HC group (Differential wave of HC group=1.347μV; Differential wave of SubD

group=0.543μV; P＜0.001).

The ANOVA on SP latencies showed all the effective effects are not significant.

TABLE 5. Description for SP Amplitude (μV) and Latency (ms) (Mean±SD)

Task Group PZ POZ OZ

Amplitude 1.217±0.378 -0.401±0.541 -.336±0.396

SD
Latency 748.840±5.440 749.451±5.499 755.249±5.160
Congruent
Amplitude -0.185±0.464 1.047±0.637 1.535±0.666
HC
Latency 746.277±5.351 744.385±4.867 749.512±5.212

Amplitude -0.720±0.465 1.695±0.702 0.792±0.652

Incongruent SD
Latency 742.981±5.778 754.211±5.637 755.676±5.468
 Amplitude 1.509±.256 1.043±0.220 1.982±0.209
HC
Latency 750.916±5.414 735.901±4.898 751.831±5.695

Discussion
Emotional conflict is a cognitive process in which we need to select our target

information and suppress irrelevant information when processing emotional

information, and the resolution of emotional conflict has great significance in real life.

This study examined the behavioral and electrophysiological correlates of emotional

conflict deficits in SubD patients.

The study found that subjects showed a significant behavioural Stroop

interference effect. Both the SubD and HC groups had longer RTs in the incongruent

condition than in the congruent condition when completing the emotional conflict

task. This is consistent with the findings of Botvinic (Botvinick MM et al., 2004),

who identified stronger activation in the prefrontal as well as the cingulate cortex in

the incongruent condition, showing a significant decrease in behavioural indicators

during response. Previous research (Etkin et al., 2006) has suggested that this is due to

a conflict between emotional and cognitive resources. When word-face emotional

valence is in conflict, word and face competition for cognitive resources, such as

attention, and the resources taken up by processes such as recognition and processing

of non-target stimuli can interfere with processes such as recognition and processing

of target stimuli, and in turn make them less efficient. This study also found that the

SubD group had significantly longer RT and lower ACC rates in both conditions

compared to the HC group, suggesting that SubD may have deficits in the cognitive
processes of emotional conflict.

Regarding the ERP data, the SubD group had greater N2 amplitude in the

frontocentral region and greater N450 difference wave amplitude in the frontocentral

region for “incongruent stimuli minus congruent stimuli” relative to the HC

group. The SubD patients and HC group showed enhanced conflict SP for

“incongruent stimuli” than for “congruent stimuli,” and the HC group showed greater

SP difference wave amplitude for “incongruent stimuli minus congruent stimuli” than

the SubD patients. This, combined with the longer RT and lower ACC behavioural

data during the task, suggests that SubD patients have neurological impairments in

monitoring and responding to emotional conflict.

For N2, the subject type main effect was significant, showing a larger wave

amplitude in the SubD group than in the HC group. N2 reflects the state of attention at

the beginning of the entire cognitive processing, and the results suggest that SubD

patients are more sensitive to the early processing of emotional stimuli than normal

individuals. The present study did not find differences in the conflict condition,

but previous studies found that the N2 amplitude of incongruent stimuli was greater

than the N2 amplitude of congruent stimuli in the interference task (Gehring WJ et al.,

1992; Kopp B et al., 1996; Holmes AJ et al., 2008), possibly because previous studies

have mostly used the classical Stroop or go-nogo paradigms, whereas the present

study used the word-face Stroop paradigm. Previous studies (Zhang JP et al.,

2021) have shown that people with SubD pay different attention to emotional

information than normal people and engage with emotional information to a greater
extent, so the N2 amplitude was more negative in the SubD group, reflecting the fact

that people with SubD require more cognitive resources to process emotional

information.

For N450, the main effect of conflict type was significant, and waves in the

incongruent condition had a greater turn in the frontal mid-lobe region than waves in

the congruent condition. N450 is a valid indicator of the Stroop interference effect

(Shen YM et al., 2013 ), and the findings suggest that there was a significant Stroop

interference effect in this study. The main effect of subject type was significant, with

the SubD group eliciting more negative N450 compared to the HC group, and an

interaction effect between subject type and conflict type was found, with further

simple effects analysis showing that the incongruent condition minus the more

congruent condition elicited greater N450 in the SubD group than in the HC

group.The N450 component can be used as an electrophysiological indicator of

conflict processing efficiency (Strommer-Davidovich N et al., 2018), which is

positively correlated with the amount of psychological resources an individual

devotes to conflict events (West R et al., 2005), and this study shows that people with

SubD have low conflict processing efficiency and high interference sensitivity. It has

also been suggested that N450 may be related to conflict monitoring (Liotti M et al.,

2000; West R et al., 2003) and conflict resolution. For example, Qiu et al. (Qiu NJ et

al., 2006) in a colour-word Stroop study using Chinese characters as materials found

N450 responded to conflict monitoring and conflict resolution processes, so in the

present study we suggest N450 reflects participants’ monitoring and resolution of

conflict between facial expressions and the meaning of emotional words associated

with the facial word Stroop task. The greater wave of difference in N450 in the SubD

group implies that SubD patients are more sensitive to the detection of emotional

conflict.

For SP, a main effect of conflict type was significant, with incongruent

conditions triggering greater SP than congruent conditions. Subject type main effects

were evident, with the SubD group triggering smaller SP amplitudes than the HC

group, which differed from the hypothesis, and an interaction effect between subject

type and conflict type was found, with the SubD group inducing smaller waves of

difference in SP in incongruent conditions minus congruent conditions than the HC

group. Many studies (Whitney C et al., 2009; Clayson PE et al., 2011; Forster SE et

al., 2011) have linked the slow wave of conflict SP to post-response monitoring and

conflict adaptation. For example, Chen et al. (Chen A et al., 2011) suggest that

conflict SP is related to post-response monitoring because this positivity extends

beyond the mean response time. Larson et al. (M.J. Larson et al., 2009) suggest that

post-response SP reflects the conflict adaptation process. Therefore, we suggest SP

responds to subjects’ monitoring of responses and conflict adaptation in the

completion of an emotional conflict task. The results of the present study imply that

adaptation and response monitoring are more delayed in people with SubD following

emotional conflict resolution.

Research has shown that the inability to resolve and adapt to emotional conflict

is typical of patients with certain mood disorders. The present study provides new
behavioural and neurophysiological evidence for impaired emotional conflict control

in patients with SubD. The findings suggest that, compared to the HC group, SubD

patients have abnormal emotional conflict inhibition using the Word-Face Stroop

task, as evidenced by greater sensitivity to early processing of emotional stimuli,

overcommitment of cognitive resources, and sharper detection of emotional conflict,

but delayed adaptation and response selection following emotional conflict. On the

one hand, these findings help us to enhance our understanding of SubD inhibition

defects, on the other hand, they also provide evidence on the cognitive

neuropsychiatric model of SubD.

Statement
All subjects complete an informed consent form and agree to publication in an online

open access publication.

The datasets generated during the current study are available in the figshare

repository, [https://doi.org/10.6084/m9.figshare.17081807.v1]

The authors declare that they have no conflflicts of interest.

This study is not funded

Author contributions: Weizhou Wang performed the statistical analysis, wrote

the manuscript, and was fully responsible for all content and editorial decisions. Qi

Xie is responsible for the experimental design and implementation of the experiment.

Weizhou Wang and Qi Xie contributed equally to the completion of the paper and are

joint first authors of the article. Lulu Zhang and Jingyi Zhou are responsible for

assisting in completing the experiment and collating the data. Associate Professor

Shuang Hu designed the entire study, trained the experimentalists and critically
evaluated the draft manuscript. All authors read and approved the final manuscript.

Author's Profile
Weizhou Wang: Lecturer, Hebei University of Economics and Trade, Research

Interests: Cognitive research in subthreshold depressed population.

Xie Qi: Lecturer, Hunan Institute of Technology, Research Interests: Near-

infrared study of depressed people.

Lulu Zhang: Master's Degree Candidate, Shandong University of Traditional

Chinese Medicine Research Interests: Social Adaptation of Left-behind Children.

Jingyi Zhou: Currently a master's student at Shandong University of Traditional

Chinese Medicine. Research Interests: Research on self-control of college students.

Hu Frost, Associate Professor, Shandong University of Traditional Chinese

Medicine, Research Interests: Psychological Theory and Application of TCM

Pictures
References
Algom, D., Chajut, E., & Lev, S. (2004). A rational look at the emotional stroop
phenomenon: a generic slowdown, not a stroop effect. Journal of Experimental
Psychology: General, 133(3), 323.
Anderson, N. D., Lau, M. A., Segal, Z.V., & Bishop, S. R. (2007). Mindfulness ‐based
stress reduction and attentional control. Clinical Psychology & Psychotherapy:
An International Journal of Theory & Practice, 14(6), 449-463.
Bai, L. , Ma, H. , Huang, Y. X. , & Luo, Y. J. . (2005). The development of native
chinese affective picture system-a pretest in 46 college students. Chinese Mental
Health Journal, 19(11)(11), 719-722.
Ballesteros, J., Bobes, J., Bulbena, A., Luque, A., Dal-Ré, R., Ibarra, N., & Güemes, I.
(2007). Sensitivity to change, discriminative performance, and cutoff criteria to
define remission for embedded short scales of the Hamilton depression rating
scale (HAMD). Journal of Affective Disorders, 102(1-3), 93-99.
Bertha, E. A., & Balázs, J. (2013). Subthreshold depression in adolescence: a
systematic review. European Child & Adolescent Psychiatry, 22(10), 589-603.
Botvinick, M. M., Cohen, J. D., & Carter, C. S. (2004). Conflict monitoring and
anterior cingulate cortex: an update. Trends in Cognitive Sciences, 8(12), 539-
546.
Buntrock, C., Berking, M., Smit, F., Lehr, D., Nobis, S., Riper, H., ... & Ebert, D.
(2017). Preventing depression in adults with subthreshold depression: health-
economic evaluation alongside a pragmatic randomized controlled trial of a web-
based intervention. Journal of Medical Internet Research, 19(1), e5.
Chen, A., Bailey, K., Tiernan, B. N., & West, R. (2011). Neural correlates of stimulus
and response interference in a 2–1 mapping stroop task. International Journal of
Psychophysiology, 80(2), 129-138.
Clayson, P. E., & Larson, M. J. (2011). Conflict adaptation and sequential trial
effects: Support for the conflict monitoring theory. Neuropsychologia, 49(7),
1953-1961.
Cuijpers, P., & Smit, F. (2004). Subthreshold depression as a risk indicator for major
depressive disorder: a systematic review of prospective studies. Acta
Psychiatrica Scandinavica, 109(5), 325-331.
De Pisapia, N., & Braver, T. S. (2006). A model of dual control mechanisms through
anterior cingulate and prefrontal cortex interactions. Neurocomputing, 69(10-12),
1322-1326.
Disner, S. G., Beevers, C. G., Haigh, E. A., & Beck, A. T. (2011). Neural mechanisms
of the cognitive model of depression. Nature Reviews Neuroscience, 12(8), 467-
477.
Epp, A. M., Dobson, K. S., Dozois, D. J., & Frewen, P. A. (2012). A systematic meta-
analysis of the Stroop task in depression. Clinical Psychology Review, 32(4),
316-328.
Etkin, A., Egner, T., Peraza, D. M., Kandel, E. R., & Hirsch, J. (2006). Resolving
emotional conflict: a role for the rostral anterior cingulate cortex in modulating
activity in the amygdala. Neuron, 51(6), 871-882.
Everaert, J., Koster, E. H., & Derakshan, N. (2012). The combined cognitive bias
hypothesis in depression. Clinical Psychology Review, 32(5), 413-424.
Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C.
J., ... & Whiteford, H. A. (2013). Burden of depressive disorders by country, sex,
age, and year: findings from the global burden of disease study 2010. PLoS
Medicine, 10(11), e1001547.
Forster, S. E., Carter, C. S., Cohen, J. D., & Cho, R. Y. (2011). Parametric
manipulation of the conflict signal and control-state adaptation. Journal of
Cognitive Neuroscience, 23(4), 923-935.
Gehring, W. J., Gratton, G., Coles, M. G., & Donchin, E. (1992). Probability effects
on stimulus evaluation and response processes. Journal of Experimental
Psychology: Human Perception and Performance, 18(1), 198.
Hamilton, M. A. X. (1967). Development of a rating scale for primary depressive
illness. British Journal of Social and Clinical Psychology, 6(4), 278-296.
Hayasaka, Y., Furukawa, T. A., Sozu, T., Imai, H., Kawakami, N., & Horikoshi, M.
(2015). Enthusiasm for homework and improvement of psychological distress in
subthreshold depression during behavior therapy: secondary analysis of data
from a randomized controlled trial. BMC Psychiatry, 15(1), 1-11.
Holmes, A. J., & Pizzagalli, D. A. (2008). Response conflict and frontocingulate
dysfunction in unmedicated participants with major
depression. Neuropsychologia, 46(12), 2904-2913.
Jiang, L., Wang, Y., Zhang, Y., Li, R., Wu, H., Li, C., ... & Tao, Q. (2019). The
reliability and validity of the center for epidemiologic studies depression scale
(CES-D) for Chinese university students. Frontiers in Psychiatry, 10, 315.
Jones, E. B., & Sharpe, L. (2017). Cognitive bias modification: A review of meta-
analyses. Journal of Affective Disorders, 223, 175-183.
Kopp, B., Mattler, U., Goertz, R., & Rist, F. (1996). N2, P3 and the lateralized
readiness potential in a nogo task involving selective response
priming. Electroencephalography and Clinical Neurophysiology, 99(1), 19-27.
Kavcic, V., & Clarke, J. M. (2000). Hemispheric interactions during a face–word
Stroop-analog task. Neuropsychology, 14(4), 579.
Larson, M. J., Kaufman, D. A., & Perlstein, W. M. (2009). Neural time course of
conflict adaptation effects on the Stroop task. Neuropsychologia, 47(3), 663-670.
LeDoux, J. E. (2000). Emotion circuits in the brain. Annual Review of Neuroscience,
23(1), 155-184.
Lee, Y. Y., Stockings, E. A., Harris, M. G., Doi, S. A. R., Page, I. S., Davidson, S. K.,
& Barendregt, J. J. (2019). The risk of developing major depression among
individuals with subthreshold depression: a systematic review and meta-analysis
of longitudinal cohort studies. Psychological Medicine, 49(1), 92-102.
Liotti, M., Woldorff, M. G., Perez III, R., & Mayberg, H. S. (2000). An ERP study of
the temporal course of the Stroop color-word interference
effect. Neuropsychologia, 38(5), 701-711.
Mikolajczyk, R. T., Maxwell, A. E., Naydenova, V., Meier, S., & El Ansari, W.
(2008). Depressive symptoms and perceived burdens related to being a student:
 Survey in three European countries. Clinical Practice and Epidemiology in
Mental Health, 4(1), 1-9.
Ottowitz, W. E., Tondo, L., Dougherty, D. D., & Savage, C. R. (2002). The neural
network basis for abnormalities of attention and executive function in major
depressive disorder: implications for application of the medical disease model to
psychiatric disorders. Harvard Review of Psychiatry, 10(2), 86-99.
Qiu, J., Luo, Y., Wang, Q., Zhang, F., & Zhang, Q. (2006). Brain mechanism of
Stroop interference effect in Chinese characters. Brain Research, 1072(1), 186-
193.
Radloff, L. S. (1977). A self-report depression scale for research in the general
population. Applied Psychological Measurements, 1, 385-401.
Shen, Y., Xue, S., Wang, K., & Qiu, J. (2013). Neural time course of emotional
conflict control: an ERP study. Neuroscience Letters, 541, 34-38.
Strommer-Davidovich, N., Lichtenstein-Vidne, L., Shrem, T., Alkoby, O., Richter-
Levin, G., Rohr, C., & Okon-Singer, H. (2018). F75. Selective Attention
Processes in ADHD: Evidence From a Modified Stroop-Flanker Task. Biological
Psychiatry, 83(9), S266-S267.
Stenberg, G., Wiking, S., & Dahl, M. (1998). Judging words at face value:
Interference in a word processing task reveals automatic processing of affective
facial expressions. Cognition & Emotion, 12(6), 755-782.
Taake, I., Jaspers-Fayer, F., & Liotti, M. (2009). Early frontal responses elicited by
physical threat words in an emotional Stroop task: Modulation by anxiety
sensitivity. Biological Psychology, 81(1), 48-57.
Thomas, S. J., Johnstone, S. J., & Gonsalvez, C. J. (2007). Event-related potentials
during an emotional Stroop task. International Journal of Psychophysiology,
63(3), 221-231.
Tipples, J., & Sharma, D. (2000). Orienting to exogenous cues and attentional bias to
affective pictures reflect separate processes. British Journal of Psychology,
91(1), 87-97.
Tuithof, M., Ten Have, M., van Dorsselaer, S., Kleinjan, M., Beekman, A., & de
Graaf, R. (2018). Course of subthreshold depression into a depressive disorder
and its risk factors. Journal of Affective Disorders, 241, 206-215.
Van Hooff, J. C., Dietz, K. C., Sharma, D., & Bowman, H. (2008). Neural correlates
of intrusion of emotion words in a modified Stroop task. International Journal of
Psychophysiology, 67(1), 23-34.
Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task
and psychopathology. Psychological Bulletin, 120(1), 3.
Wang, Y., Huang, H., Yang, H., Xu, J., Mo, S., Lai, H., ... & Zhang, J. (2019).
Influence of EEG references on N170 component in human facial
recognition. Frontiers in Neuroscience, 13, 705.
Wei, D., Qiu, J., Tu, S., Tian, F., Su, Y., & Luo, Y. (2010). Earthquake experience
interference effects in a modified Stroop task: an ERP study. Neuroscience
Letters, 474(3), 121-125.
West, R., Jakubek, K., Wymbs, N., Perry, M., & Moore, K. (2005). Neural correlates
of conflict processing. Experimental Brain Research, 167(1), 38-48.
West, R. (2003). Neural correlates of cognitive control and conflict detection in the
Stroop and digit-location tasks. Neuropsychologia, 41(8), 1122-1135.
Whitney, C., Grossman, M., & Kircher, T. T. (2009). The influence of multiple
primes on bottom-up and top-down regulation during meaning retrieval:
evidence for 2 distinct neural networks. Cerebral Cortex, 19(11), 2548-2560.
Xue, S., Wang, S., Kong, X., & Qiu, J. (2017). Abnormal neural basis of emotional
conflict control in treatment-resistant depression: An event-related potential
study. Clinical EEG and Neuroscience, 48(2), 103-110.
Zhang, J., Li, X., Du, J., Tan, X., Zhang, J., Zhang, Y., ... & Kong, J. (2021).
Impairments of Implicit Emotional Neurocognitive Processing in College
Students With Subthreshold Depression: An ERP Study. Journal of Clinical
Neurophysiology, 38(3), 192-197.