Aberrant insula activity to negative and reduced learning from positive feedback underlie maladaptive self-beliefs in depression

Background Maladaptive self-beliefs are a core symptom of major depressive disorder. These beliefs are perpetuated by a negatively biased integration of self-related feedback. Understanding the neurocomputational mechanisms of biased belief updating may help to counteract maladaptive beliefs and the maintenance of depression. Methods The present study uses a belief-updating task and functional neuroimaging to examine the neurocomputational mechanisms associated with self-related feedback processing in individuals with major depression ( n = 35) and matched healthy controls ( n = 32). We hypothesized that increased symptom burden in depression is associated with negatively biased self-belief updating and altered hemodynamic responses to social feedback. Results Our findings show that, in the clinical sample, the incorporation of unexpected positive feedback was reduced with greater symptom burden, and that insula reactivity was generally elevated to unexpected negative feedback. Conclusion The interplay of increased hemodynamic responsiveness to negative feedback and the reduced learning from positive feedback provide new insights into cognitive distortions in depression and may explain the persistence of maladaptive self-beliefs and, thus, the maintenance of depression.