Modulating the value of positive feedback does not influence expectation change in major depression – What can be learned from a failed replication?

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Mimi Houben, Winfried Rief, Thomas Gärtner, Tobias Kube This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4819708/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Depression is related to a reduced update of negative expectations in response to positive information. Here, we aimed to replicate that cognitive immunization (a cognitive devaluation of expectation-disconfirming information) modulates expectation updating in depression. Further, we examined how other cognitive factors (i.e., memory, interpretation) relate to cognitive immunization. Method: We examined 139 inpatients (18-75 years) diagnosed with major depression. Participants completed a false-feedback task, in which they received unexpectedly positive standardized feedback. Cognitive immunization was manipulated via text that framed the feedback as particularly valid vs. invalid, relative to a distraction-control group and a no-instruction control group. Results: There were no significant group differences in expectation updating. One interpretation questions the effect of the manipulation of cognitive immunization, which was not successful according to the manipulation check. The experimental conditions did not differ in their memory or interpretation of the feedback. However, negative interpretations were associated with elevated cognitive immunization. Conclusions: Our study failed to replicate that cognitive immunization modulates expectation updating in depression - most likely due to the failure of the cognitive immunization manipulation. Future research may need to use a stronger and easier to understand manipulation (e.g., video instead of text; simpler wording) to modulate cognitive immunization successfully. Belief updating Cognitive immunization Cognitive factors Expectation Depression Figures Figure 1 Figure 2 Figure 3 Introduction Expectations have been defined as beliefs about the likelihood of future events or experiences (Panitz et al., 2021 ). The ability to adjust expectations in response to new experiences is crucial for mental health. Conversely, a lack of this ability is considered a core feature of many mental disorders (Rief & Joormann, 2019 ). Especially in people with major depressive disorder (MDD), research has provided evidence for a lack of updating negative expectations in response to novel positive information (for a review, see Kube, 2023 ). As such, several studies examining clinical (Kube, Glombiewski, et al., 2019 ), subclinical (Kube et al., 2023 ), and non-clinical samples (Kube & Glombiewski, 2021 , 2022) found depressive symptoms to be related to a reduced adjustment of negative performance expectations in response to positive performance feedback. In addition, depression has been shown to be associated with a reduced revision of negative interpretations of ambiguous interpersonal situations in response to novel positive information (Deng et al., 2022 ; Everaert et al., 2018 , 2020 ). To account for these problems and facilitate experiential learning in therapy, it is crucial to elucidate the mechanisms underlying deficient expectation update in depression (Rief et al., 2022 ). Recent evidence suggests that, in addition to interpretation bias (Deng et al., 2022 ; Everaert et al., 2020 ), memory bias (Marchetti et al., 2018 ), attention bias (Keller et al., 2019 ), and other cognitive factors, "cognitive immunization" might be one such mechanism. Cognitive immunization is referred to as the post-hoc devaluation of expectation-disconfirming experiences through defensive cognitive strategies (Kube et al., 2017 ). For example, the value of an unexpectedly positive experience, such as passing an exam, might be questioned post-hoc by thinking, “This was a particularly easy exam – anyone could have passed it”. As a result, the original expectation (e.g., “I will fail”) is maintained. In line with this suggestion, research has shown that such thinking contributes to the persistence of negative expectations despite positive disconfirming evidence (Kube, 2023 ). Specifically, the experimental modulation of cognitive immunization (promoting vs. inhibiting it) in a subclinical student sample led to significant differences in the adjustment of performance expectations following positive feedback (Kube, Rief, et al., 2019 ). Similarly, in a clinical sample of patient with MDD, the inhibition of cognitive immunization boosted the update of negative performance expectations in response to positive performance feedback (Kube, Glombiewski, et al., 2019 ). However, little is known about how cognitive immunization relates to other cognitive factors and whether it is really a distinct cognitive process. To our knowledge, only one recent study looked into the relationship between cognitive immunization and another well-known cognitive bias, that is, interpretation bias. In that study using a healthy student sample (partly with elevated depressive symptoms), there was no correlation between cognitive immunization and interpretation bias (Würtz et al., 2024 ). Aims and hypotheses Our study had two main objectives: first, to replicate the results of Kube, Rief, et al. ( 2019 ) regarding the influence of cognitive immunization on expectation update; and second, to take into account other factors that could potentially influence expectation update, namely, interpretation and memory. To pursue the first goal, we used an experimental modulation protocol, in which the engagement in cognitive immunization was promoted in one condition (immunization promotion group = IPG), whereas it was inhibited in another one (immunization inhibition group = IIG). In addition, there were two control groups: one control group that received no manipulation whatsoever (no-instruction control group (NCG), and a distraction control group (DCG) that allowed us to test whether the content of the cognitive immunization manipulation made a real difference in expectation update, or whether the interruption of the procedure by any instruction could account for possible differences in expectation update. Our key hypothesis was that the IIG would show more expectation update than the IPG and the two control groups. In addition, we hypothesized that the IPG would show less expectation update than the two control groups. In terms of a manipulation check, we hypothesized that the IIG would report less cognitive immunization than the IPG and the two control groups. Relatedly, we hypothesized that the IPG would report more cognitive immunization than the two control groups. Regarding the second goal, we hypothesized that the four experimental groups will not differ in their interpretation of the feedback and in their recall of it. Methods The study was approved by the local ethics committee (reference number: 2019-16k) and was conducted in accordance with ethical standards (1964 Declaration of Helsinki and its later amendments). All participants gave informed consent and were treated in accordance with the ethical guidelines of the German Psychological Society. The study was preregistered at aspredicted.org ( https://aspredicted.org/CNC_RLF ). Participants For the a-priori power analysis, we assumed a medium effect size, based on previous research on the modulation of cognitive immunization (Kube, Glombiewski, et al., 2019 ). Accordingly, the a-priori power analysis using G*Power for a repeated measures ANOVA (expected η p 2 = .080; Power = .80; α = .05; numerator df: 3) indicated a minimum sample size of 131. Participants were patients with major depression that were recruited at a German psychosomatic inpatient hospital, where they received non-manualized cognitive behavioral therapy for depression. The study was labelled as a study to investigate the influence of current mood on performance. Inclusion criteria were: current diagnosis of MDD as ascertained by a diagnostic interview; age of at least 18 years; and sufficient German language skills. Participants were excluded if they had participated in a previous study using a similar paradigm or if they correctly guessed the real purpose of the study after completion. Participants were diagnosed by trained master students of clinical psychology using semi-structured clinical interview (Klein et al., 2018 ). As part of the diagnostic interview, it was determined whether the participants met the DSM-5 criteria of a persistent depressive disorder (PDD) or non-persistent MDD. A systematic investigation into how episodic and persistent depressive disorder differ in terms of expectation update, cognitive immunization, and other cognitive aspects, will be reported elsewhere. Participants received 15 EUR as a financial compensation for their participation. Procedure The present study used a well-established false feedback paradigm to investigate change in performance expectations in depression (Kube et al., 2018 ). Data were collected between November 2021 and January 2023. First, the diagnostic interview was conducted. If the inclusion criteria were met, participants next completed the study in a standard laboratory room at the hospital. Data were entered using the survey platform soscisurvey.de. All measures were completed in German language. Figure 1 illustrates the study procedure. Induction of negative baseline expectations. Participants were informed that they would have to take a very difficult performance test with which they are unfamiliar. The goal was to lower participants’ initial performance expectations. Subsequently, we asked participants to indicate their initial performance expectations. Performance test. Participants completed the TE st of EM otional INT elligence (TEMINT; Schmidt-Atzert & Buehner ( 2002 ). In the TEMINT, the participants’ task is to empathize with other people and estimate what emotions they felt in certain situations. To this end, participants are provided with 12 emotionally relevant situations that other people experienced (e.g. female dental assistant, age 23): “I was about to give birth to my first child”). For each of the 12 situations, participants indicate the extent to which the person described in the situation felt certain emotions (e.g., anger, sadness, pride). The TEMINT has several advantages that make it suitable for the paradigm: For instance, it is difficult for participants to evaluate their own performance, which is important for the manipulated performance feedback to appear credible. Furthermore, depression is unrelated to performance deficits in this test (Kube et al., 2022 ). Participants’ actual performance in this test was not relevant to the research question of the present study and is therefore not examined further. Performance feedback. After completing the TEMINT, participants received manipulated feedback. According to this feedback, participants had solved the majority of the tasks from the test correctly. In addition, as in previous studies (Kube, Rief, et al., 2019 ), participants were fed back that they are among the top 15% of all people who worked on this test. This feedback aimed to disconfirm initial negative performance expectations. Experimental conditions. Following the performance feedback, participants from the IPG were presented a text in which it was stated that the performance test they just completed has been shown to produce unreliable results and has been shown to be unrelated to any real-world outcomes. This manipulation was supposed to enhance people’s propensity to ignore the positive performance feedback and sustain their initial performance expectations. Participants from the IIG were presented a text of equal length and style, in which they were informed that the performance test they completed has been found to be highly reliable and predictive of a number of outcomes of people’s personal and professional life. More specifically, participants were informed that people who perform well on the TEMINT (and thus are highly competent in assessing other people’s emotions) often have more satisfying relationships and more professional success. This manipulation was intended to prevent participants from devaluing the positive performance feedback and thereby to boost expectation update. In the DCG, participants completed a well-established distraction task of 90 sec length, after receiving the performance feedback. Participants were asked to vividly imagine different scenarios (e.g. A ship crossing the Atlantic) (Nolen-Hoksema & Morrow, 1933 ). In the NCG, the study was paused for 90 sec. After the experimental manipulations, we asked participants to indicate their performance expectation to succeed in similar tests in the future and assessed cognitive immunization strategies, interpretation and memory. Follow-up measures and debriefing. After completing the paradigm, several follow-up questionnaires were administered to assess socio-demographics and depressive symptoms. Finally, the participants were informed about the actual purpose of the study. Measures Changes in expectations. We assessed task-specific and generalized expectations with two scales, each comprising two items. For the wording of the items see (Kube, Rief, et al., 2019 ). All items were rated on a seven-point Likert scale ranging from (1) “I totally disagree” to (7) “I totally agree”. The total score for both the task-specific and the generalized expectations ranges from 2 to 14. Internal consistency of the generalized expectations scale was α = .83 before the test and α = .66 after feedback. For the task-specific expectations scale, internal consistency was α = .81 before the test and α = .76 after feedback. As in previous studies (Kube, Glombiewski, et al., 2019 ; Kube, Rief, et al., 2019 ), we pre-defined pre to post changes in generalized expectations as the primary outcome, and the update of task-specific expectations as the secondary outcome. Cognitive Immunization. We measured cognitive immunization using the Cognitive Immunization after Performance Feedback (CIPF) Scale. The scale has shown good psychometric properties in previous studies and comprises six items. Two items assess the extent to which participants question the credibility of the feedback. Two items assess the relevance of the feedback. The last two items assess whether participants see their feedback in the TEMINT as a rather untypical result for their personal performance assessment. For the exact wording, see (Kube, Glombiewski, et al., 2019 ). Each item was rated on a seven-point Likert scale ranging from (1) “I totally disagree” to (7) “I totally agree”. Thus, the total score of the CIPF scale ranges from 6 to 42. Higher values reflect a greater engagement in cognitive immunization strategies. Internal consistency of the six-item CIPF scale was α = .79. The CIPF-score was significantly correlated with change in generalized ( r = − 0.151, p = .035) and task-specific ( r = − 0.151, p = .035) expectations. Memory. To assess memory performance, participants were asked to free-recall their test result. Interpretation. To assess how participants interpreted the performance feedback, they were asked to indicate whether they perceived their test result as “clearly above average”, “slightly above average”, “average”, “slightly below average” or “clearly below average”. Depressive Symptoms. We assessed depressive symptoms using the second edition of the Beck Depression Inventory (BDI- II; Beck et al., 1996 ). The BDI-II compromises 21 items with a 4-point scale ranging from 0 to 3. The sum score ranges between 0 and 63, and lower values indicate fewer depressive symptoms. Internal consistency of the BDI-II was α = .91. Furthermore, we assessed dispositional optimism and sociodemographic basic variables, as detailed in the supplements. Statistical analysis We conducted data screening according to (Tabachnik & Fidell ( 2014 ) and tested the assumptions of analyses of variance (ANOVA). We excluded participants deviating > 3 standard errors from the mean as outliers. This is in line with the recommendations by (Stevens, 2002 ) and ensures the analysis is not influenced by highly influential or errant data points. For the main analysis, we conducted a 2 (Time: pre vs. post feedback) × 4 (Condition: immunization promotion vs. immunization inhibition vs. attention control group vs. no task control group) mixed ANOVA, with the generalized performance expectations as the dependent variable. To examine group differences in expectation update, the analysis of most interest is the interaction between the factors Time and Condition. Same applies to task specific expectations as the secondary outcome. As a manipulation check, possible differences between conditions were examined in a one factorial ANOVA with the CIPF total scores as the dependent variable. Type-1 error levels were set at 5% (two-tailed). All analyses were conducted using IBM SPSS Statistics Version 29. Results Sample Characteristics Table 1 Sociodemographic characteristics Variable Immunization Promotion group ( n = 34) Immunization Inhibition group ( n = 36) No-task control group ( n = 33) Distraction control group ( n = 36) Age in years, M ( SD ) 43.8 (16.7) 44.7 (15.8) 43.7 (15.3) 43.6 (11.8) Sex, N (%) male 13 (38.2) 11 (30.6) 12 (36,4) 15 (41,7) female 21 (61.8) 25 (69.4) 21 (63,6) 21 (58,3) Educational level, N (%) No educational degree 0 0 0 0 Primary education 1 (2.9) 2 (5.6) 3 (9.1) 2 (5.6) Secondary education 19 (55.8) 20 (55.6) 21 (63.7) 18 (50.0) Higher education 14 (41.1) 14 (38.9) 9 (27.3) 16 (44.4) Employment status, N (%) Full-time working 17 (50.0) 16 (44.4) 16 (48.5) 19 (52.8) Part-time working 2 (5.9) 12 (33.3) 10 (30.3) 9 (25.0) In training 4 (11.8) 3 (8.3) 2 (6.1) 1 (2.8) Unemployed 4 (11.8) 1 (2.8) 2 (6.1) 3 (8.3) Pensioners 6 (17.6) 3 (8.3) 1 (3.0) 1 (2.8) Disabled 1 (2.9) 1 (2.8) 2 (6.1) 3 (8.3) BDI-II scores, M ( SD ) 29.3 (10.3) 29.1 (10.8) 29.5 (11.0) 31.3 (11.3) Diagnosis, N (%) Non-persistent MDD 21 (61.8) 18 (50.0) 18 (54.5) 19 (52.8) PDD 13 (38.2) 18 (50.0) 15 (45.5) 17 (47.2) Note. M , mean; SD , standard deviation; N , number; BDI-II, Beck Depression Inventory II; MDD, Major depressive disorder; PDD, Persistent depressive disorder In total, we recruited 179 participants. Of these, 28 participants were excluded because they did not meet the criteria of MDD. Another 4 participants were excluded because they correctly guessed the real purpose of the study. Two participants were excluded because they had taken part in a previous study of our research group using the same paradigm. Additionally, 4 participants were excluded as they did not want to complete the study for the following reasons: concerns about data safety (n = 1), difficulty concentrating (n = 2), fire alarm (n = 1). Another 2 participants were identified as statistical outliers (> 3 SD above/below the mean) and were therefore excluded. Thus, subsequent analyses are based on data from 139 participants. Of these, 75 people met the criteria of PDD, while 64 people suffered from non-persistent MDD. In contrast to Kube et al. ( 2019 ), depressive symptom burden was severe in the current sample, as indicated by a BDI-II sum score of M = 29.8 ( SD = 10.8, range = 10–57). Also, our participants were older, M = 43.9 years old ( SD = 14.8, range 18–75) and more diverse in their educational degrees (see Table 1 ). Comparable to Kube et al. ( 2019 ), 63.3% of the sample identified themselves as female and 97.1% stated German as their native language. Sociodemographic characteristics are presented in Table 1 . According to recommendation of de Boer et al. ( 2015 ) we did not check for baseline differences between groups, further sample characteristics are detailed in the Supplements (table A.1). Manipulation Check: Differences in cognitive Immunization Cognitive immunization significantly differed between groups, F (3, 135) = 5.49; p = .001; η 2 p = .109; 95%CI [.019, .198]. To further examine group differences, we conducted Bonferroni-corrected pairwise comparisons. As expected, the IIG ( M = 19.97; SD = 6.82) reported significantly less cognitive immunization ( p = .040; d = 0.67; 95%-CI [0.18–1.15]) than the NCG ( M = 24,82; SD = 7.81) and significantly less cognitive immunization ( p = .003, d = 0.85; 95%CI [0.36 − .1.33]) than the DCG ( M = 26.17; SD = 7.49). The NCG and the DCG did not significantly differ ( p > .999), as expected. Contrary to the rationale of the manipulation, the IPG ( M = 21.50; SD = 7.03) did not significantly differ from the NCG ( p = .388), DCG ( p = .050), and the IIG ( p < .999). Thus, the manipulation was only partly successful: While the IIG lowered the engagement in cognitive immunization as compared to the control groups as hypothesized, the IPC was not successful in increasing participants’ engagement in cognitive immunization (see Fig. 2). Main Analysis: Changes in expectations To our surprise, the four groups did not significantly differ in the extent to which they updated their generalized expectations, as indicated by a non-significant Time by Condition interaction, F (3, 135) = 0.57; p = .637; η 2 p = .004; 95%CI [0, .051]. Overall, participants updated their generalized expectations in a positive direction, as indicated by a significant main effect of Time, F (1, 135) = 24.67; p < .001; η 2 p = .154; 95%CI [.071, .245]. As expected, the main effect of Condition was not significant, F (3, 135) = 1.35; p = .260; η 2 p = .029; 95%CI [0, .086]. The same pattern of results was found for task specific expectations (see supplements). Thus, differences in cognitive immunization were not translated into differences in expectation update (see Fig. 3). Descriptive statistics of generalized expectations, task specific expectations, and CIPF ratings are detailed in Table 2 . Additional Analyses Regarding the influence of other cognitive factors, the groups did not significantly differ in their interpretation of the feedback, F (3,135) = 2.19; p = .091, η 2 p = .046; 95%CI [0, .114] and there was no significant correlation of interpretation and generalized expectation update ( r = − .123; p = .149), as expected. Similarly, the groups did not differ in the height of their memory error, F (3, 135) = 1.61; p = .190; and η 2 p = .035; 95%CI [0, .095] and there was no significant correlation of memory error and generalized expectation update ( r = .078; p = .182). Cognitive immunization did significantly correlate with a more negative interpretation of the feedback ( r = − .254; p = .003). Cognitive immunization was not significantly correlated with memory error ( r = .113; p = .185). Table 2 Expectation and cognitive Immunization rating of the four experimental groups. Variable Immunization Promotion group ( n = 34) Immunization Inhibition group ( n = 36) No-task control group ( n = 33) Distraction control group ( n = 36) Generalized expectation, M ( SD ) Pre 7.62 (2.90) 8.14 (2.38) 7.42 (2.78) 7.42 (2.81) Post 8.82 (3.05) 9.56 (2.31) 9.00 (2.47) 8.14 (2.81) Task-specific expectation, M ( SD ) Pre 7.97 (2.84) 8.78 (2.53) 8.06 (3.17) 8.44 (3.02) Post 11.24 (2.30) 11.25 (2.31) 10.58 (2.31) 10.53 (2.62) CIPF scale. M ( SD ) 21.50 (7.03) 19.97 (6.82) 24.82 (7.80) 26.17 (7.49) Note. M . mean; SD . standard deviation; CIPF scale. Cognitive Immunization after Performance Feedback Scale Symptom severity was significantly correlated with more engagement in cognitive immunization ( r = .176; p = .019) and more negative baseline (generalized) expectations ( r = − .29; p < .001), but not with less change of generalized expectations ( r = − .100; p = .120). Due to the standardized (i.e., non-personalized) nature of the feedback (“you are among the best 15%”), it conveyed larger prediction errors for people with low baseline expectations, and larger prediction errors naturally result in a greater adjustment of expectations (Rescorla & Wagner, 1972 ). Accordingly, we reran the main analysis with baseline expectations as a covariate. As the time by condition interaction remained insignificant, F (3, 135) = 1.277, p = .285, η 2 p = .046; 95%CI [0, .114], differences in baseline expectations can be ruled out as a significant confounding factor. Since depressive symptoms were related to more negative baseline expectations, the resulting larger prediction errors could have suppressed a relationship between depressive symptoms and expectation update. Therefore, we also computed a partial correlation between depressive symptoms and expectation update, while controlling for baseline expectations, which was significant ( r = − .321; p < .001), indicating that higher depressive symptoms were associated with less expectation update. To generate additional hypotheses for the failure of the manipulation, we conducted several additional exploratory analyses. As outlined in the supplements, these analyses did not reveal any covariate that could account for the non-significant group differences in expectation update. Discussion The aim of this study was to replicate that cognitive immunization modulates expectation update in depression, and to explore the role of other potentially relevant factors (interpretation, memory). The manipulation check indicated that the manipulation of cognitive immunization was only partly successful: while the IIG reported less cognitive immunization than the two control groups, as intended, the IPG did not differ from the two control groups in cognitive immunization, although cognitive immunization was intended to be increased in this condition. The manipulation therefore seems to have partially failed. Furthermore, even the successfully lowered engagement in cognitive immunization in the IIG was not reflected by significant group differences in expectation update. Thus, the present study failed to replicate that the modulation of cognitive immunization leads to differences in expectation update in depression (Kube, Rief, et al., 2019 ). A number of reasons might account for this failure. In contrast to (Kube, Rief, et al., 2019 ), who examined a sub-clinically depressed (BDI-II > 9) student sample, the current study used an inpatient clinical sample with relatively high symptom burden and diverse educational degrees. These important sample differences could account for the failure of the manipulation as the written manipulation texts were quite complex and might have been too difficult to understand for a severely impaired participant. More specifically, the manipulation text focused quite heavily on the good vs. bad criterion validity of the TEMIT performance test, which may have required deductive reasoning to understand its implications for the participants. On the other hand, it should be noted that the same manipulation text was successfully used in one experimental condition of another previous study with a similarly impaired clinical sample to inhibit cognitive immunization and promote expectation update (Kube, Rief, et al., 2019 ). Another possible explanation refers to the fact that in the current study we conducted a diagnostic interview before participants worked on the performance test. This interview, which was perceived as pleasant by many patients, might have reduced negative affect, which could have resulted in greater openness to integrating unexpectedly positive performance feedback, as suggested by previous research (Kube et al., 2023 ; Kube & Glombiewski, 2020 ). Würtz and colleagues ( 2024 ) found that a lack of group differences was most likely attributable to regression to the mean and depressive symptoms being associated with less positive baseline expectations, which leave more room for an increase of positive expectations. In our study, we also found a small correlation of baseline expectations and depressive symptoms, However, as controlling for baseline expectations did not change the results in our study, these factors do not seem to make a difference in our case. Further possible explanations concern the characteristics of the manipulation. First the manipulation was presented subsequently to the presentation of the feedback. If immunization was an automated process immediately following expectation violation, the manipulation might have been carried out too late to influence it. Second, the manipulation consisted of a scientific-factual argumentation presented as a text. As research on open label placebo, as well as on therapy expectations, suggests that the warmth of a presenter is key to the effectiveness of such a rationale (Gaab et al., 2019 ; Seewald & Rief, 2023 ), it is possible that including a warm presenter would have enhanced the effectiveness of our manipulation. Beyond that, it could be argued that labelling the test as invalid makes the feedback less relevant for the self-concept and - as a paradoxical consequence - easier to integrate. This would also fit in with the finding that shows that feedback that is too positive is less integrable (Kube et al., 2021 ; Würtz et al., 2024 ). Nevertheless, this explanation is unlikely to account for the failed replication, as otherwise labelling the test as invalid would also have to lead to a higher integration of the feedback. In terms of the feedback that was used in the present study, these findings could very well be relevant. As they show that moderately positive feedback ("you are among the best 15%") leads to the strongest change in expectations and the lowest degree of cognitive immunization (Kube et al., 2021 ; Würtz et al., 2024 ). Thus, more extreme positive feedback (“you are among the best 1%”) could be more suitable to modulate cognitive immunization. However, this does not explain the discrepancy with Kube, Rief, and colleagues (2019), but as detailed out before the sample used in this previous study may had less difficulties in understanding the manipulation, which may be why cognitive manipulation was manipulated successfully despite the moderately positive feedback. Overall, participants showed a positive expectation update. This may contradict the results from previous research showing that depression is related to little expectation update in response to positive information (as reviewed by Kube, 2023 ). However, since there was no other population as a control sample, this positive update is difficult to interpret regarding its magnitude, and it could be just a measurement repetition effect. Finally, replication of empirical social science results is - due to possibly high false failure rates, even in well powered samples- nothing that can be automatically expected, and non-replication in one trial does not automatically imply that the effect is not robust. (Schauer & Hedges, 2021 ; Stanley & Spence, 2014 ). On the other hand, the robustness of the effect can only be evaluated in the long run and therefore further research is needed. Strengths, Limitations and future directions Strengths of our work can be seen in the sufficiently powered clinical sample; the use of a previously validated paradigm; the use of two control groups; the conduction of manipulation checks; the analysis of cognitive immunization in relation to other cognitive factors; and the pre-registration. Notwithstanding these merits, the present studies also have limitations that need to be considered. A major limitation is that we used quite complex manipulation texts and did not check whether these were comprehended correctly. Thus, we cannot clarify whether the manipulation failed because the participants did not understand the relatively complex wording and content. The fact, that the manipulation partially failed speaks to this possibility. Additionally, the manipulation texts focused only on one immunization strategy (i.e., questioning the validity of expectation-disconfirming information). Therefore, future research may use simpler wording, focus on additional immunization strategies (e.g., considering new evidence to be an exception), and check whether the manipulation is understood correctly. Presenting the manipulation as a video instead of a text may also improve comprehensibility. Moreover, we did not control for participants’ state affect and therefore cannot rule out whether the diagnostic interview beforehand induced positive affect and facilitated the expectation update. A further limitation pertains to the TEMINT, which might not have been relevant enough to participants and thus have led to limited engagement with the feedback and the subsequent manipulations. Finally, the assessment of expectations via explicit questions using numeric rating scales can be questioned as method to assess expectation change. Conclusions This study failed to replicate that cognitive immunization modulates expectation update in a sufficiently powered clinical sample of patients with MDD. Only the immunization inhibition group reported the expected reduced levels of cognitive immunization, whereas the immunization promotion group did not differ from the control groups. Therefore, our manipulation failed at least partly and future research may need to use other manipulations of cognitive immunization that are more powerful and easier to understand. Finally, the robustness of the effect of cognitive immunization on expectation update can only be evaluated in the long run and therefore further research is needed. Declarations Data Statement After careful consideration, we have decided to make the data available only on request. This is in line with the DFG's recommendations, as the place of data collection is public and the data is therefore particularly sensitive Appendix A. Supplementary data Supplementary data to this article can be found online at References Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients. Journal of Personality Assessment , 67 (3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13 de Boer, M. R., Waterlander, W. E., Kuijper, L. D. 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Clinical Psychology Review , 103 (May), 102298. https://doi.org/10.1016/j.cpr.2023.102298 Kube, T., Friehs, T., Glombiewski, J. A., & Gollwitzer, M. (2022). Depression is not related to deficits in emotional reasoning skills. Personality and Individual Differences , 196 . https://doi.org/10.1016/j.paid.2022.111728 Kube, T., & Glombiewski, J. A. (2020). How Depressive Symptoms Hinder Positive Information Processing: An Experimental Study on the Interplay of Cognitive Immunisation and Negative Mood in the Context of Expectation Adjustment. Cognitive Therapy and Research , 0123456789 . https://doi.org/10.1007/s10608-020-10191-4 Kube, T., & Glombiewski, J. A. (2021). No Evidence for the Involvement of Cognitive Immunisation in Updating Beliefs About the Self in Three Non-Clinical Samples. Cognitive Therapy and Research . https://doi.org/10.1007/S10608-021-10256-Y Kube, T., Glombiewski, J. A., Gall, J., Touissant, L., Gärtner, T., & Rief, W. (2019). How to modify persisting negative expectations in major depression? An experimental study comparing three strategies to inhibit cognitive immunization against novel positive experiences. Journal of Affective Disorders , 250 (February), 231–240. https://doi.org/10.1016/j.jad.2019.03.027 Kube, T., Kirchner, L., Gärtner, T., & Glombiewski, J. A. (2023). How negative mood hinders belief updating in depression: Results from two experimental studies. Psychological Medicine , 53 (4), 1288–1301. https://doi.org/10.1017/S0033291721002798 Kube, T., Kirchner, L., Lemmer, G., & Glombiewski, J. A. (2021). How the Discrepancy Between Prior Expectations and New Information Influences Expectation Updating in Depression—The Greater, the Better? Clinical Psychological Science . https://doi.org/10.1177/21677026211024644 Kube, T., Rief, W., & Glombiewski, J. A. (2017). On the maintenance of expectations in major depression - Investigating a neglected phenomenon. Frontiers in Psychology , 8 (JAN), 1–7. https://doi.org/10.3389/fpsyg.2017.00009 Kube, T., Rief, W., Gollwitzer, M., Gärtner, T., & Glombiewski, J. A. (2019). Why dysfunctional expectations in depression persist - Results from two experimental studies investigating cognitive immunization. Psychological Medicine , 49 (9), 1532–1544. https://doi.org/10.1017/S0033291718002106 Kube, T., Rief, W., Gollwitzer, M., & Glombiewski, J. A. (2018). Introducing an EXperimental Paradigm to investigate Expectation Change (EXPEC). Journal of Behavior Therapy and Experimental Psychiatry , 59 (November 2017), 92–99. https://doi.org/10.1016/j.jbtep.2017.12.002 Marchetti, I., Everaert, J., Dainer-Best, J., Loeys, T., Beevers, C. G., & Koster, E. H. W. (2018). Specificity and overlap of attention and memory biases in depression. Journal of Affective Disorders , 225 , 404–412. https://doi.org/10.1016/j.jad.2017.08.037 Nolen-Hoksema, S., & Morrow, J. (1933). Effects of rumination and distraction on naturally occurring depressed mood. Cognition & Emotion , 7 (6), 561–570. Panitz, C., Endres, D., Buchholz, M., Khosrowtaj, Z., Sperl, M. F. J., Mueller, E. M., Schubö, A., Schütz, A. C., Teige-Mocigemba, S., & Pinquart, M. (2021). A Revised Framework for the Investigation of Expectation Update Versus Maintenance in the Context of Expectation Violations: The ViolEx 2.0 Model. Frontiers in Psychology , 12 (November). https://doi.org/10.3389/fpsyg.2021.726432 Rescorla, R. A., & Wagner, A. R. (1972). A theory of Pavlovian conditioning: Variations in the effectiveness of reinforcement and nonreinforcement. Classical Conditioning II: Current Research and Theory, 2 , 64–99. Rief, W., & Joormann, J. (2019). Revisiting the Cognitive Model of Depression: The Role of Expectations. Clinical Psychology in Europe , 1 (1). https://doi.org/10.32872/cpe.v1i1.32605 Rief, W., Sperl, M. F. J., Braun-koch, K., Khosrowtaj, Z., Schwarting, R. K. W., Teige-mocigemba, S., Kirchner, L., Sch, L., & Panitz, C. (2022). Using expectation violation models to improve the outcome of psychological treatments . 98 (October). https://doi.org/10.1016/j.cpr.2022.102212 Schauer, J. M., & Hedges, L. V. (2021). Reconsidering statistical methods for assessing replication. Psychological Methods , 26 (1), 127–139. https://doi.org/10.1037/met0000302 Schmidt-Atzert, L., & Buehner, M. (2002). Developement of a performance measure of emotional intelligence. 43rd Congress of the German Psychological Society Berlin . Seewald, A., & Rief, W. (2023). How to Change Negative Outcome Expectations in Psychotherapy? The Role of the Therapist’s Warmth and Competence. Clinical Psychological Science , 11 (1), 149–163. https://doi.org/10.1177/21677026221094331 Stanley, D. J., & Spence, J. R. (2014). Expectations for Replications: Are Yours Realistic? Perspectives on Psychological Science , 9 (3), 305–318. https://doi.org/10.1177/1745691614528518 Stevens, J. (2002). Applied Multivariate Statistics for the Social Sciences, (2nd ed.). Erlbaum, Lawrence. Tabachnik, B. G., & Fidell, L. S. (2014). Using multivariate statistics (6th ed.). Pearson. Würtz, F., Kube, T., Woud, M. L., Margraf, J., & Blackwell, S. E. (2024). Reduced Belief Updating in the Context of Depressive Symptoms: An Investigation of the Associations with Interpretation Biases and Self-Evaluation. Cognitive Therapy and Research . https://doi.org/10.1007/s10608-023-10454-w Additional Declarations The authors declare no competing interests. Appendix not available with this version. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4819708","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333007374,"identity":"39e5959a-b0c7-40da-b8f6-6a7de6de243e","order_by":0,"name":"Mimi Houben","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-7197-1179","institution":"Department of Psychology, Philipps University of Marburg, Germany","correspondingAuthor":true,"prefix":"","firstName":"Mimi","middleName":"","lastName":"Houben","suffix":""},{"id":333007375,"identity":"e94852d8-7c37-4a58-8d91-f66756d88b27","order_by":1,"name":"Winfried Rief","email":"","orcid":"","institution":"Department of Psychology, Philipps University of Marburg, Germany","correspondingAuthor":false,"prefix":"","firstName":"Winfried","middleName":"","lastName":"Rief","suffix":""},{"id":333007376,"identity":"91f0c525-050d-47c6-9462-5313520f9b7e","order_by":2,"name":"Thomas Gärtner","email":"","orcid":"","institution":"Schön Klinik Bad Arolsen, Hofgarten 10, 34454, Bad Arolsen, Germany","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Gärtner","suffix":""},{"id":333007377,"identity":"7d7b3af0-0ac8-4d61-9f6e-2464927f03e9","order_by":3,"name":"Tobias Kube","email":"","orcid":"","institution":"Department of Psychology, University of Kaiserslautern-Landau, Germany","correspondingAuthor":false,"prefix":"","firstName":"Tobias","middleName":"","lastName":"Kube","suffix":""}],"badges":[],"createdAt":"2024-07-29 06:59:05","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4819708/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4819708/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61419297,"identity":"8db9e25a-6788-4b1b-84ef-4f9ac0c41f03","added_by":"auto","created_at":"2024-07-30 13:34:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91478,"visible":true,"origin":"","legend":"\u003cp\u003eDesign of the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e. The Diagnostic interview was followed by the induction of negative expectations and the first assessment of expectations. Participants worked on the performance test TEMINT and received standardized positive feedback. Subsequently expectations were assessed again.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4819708/v1/590e7b03223f677fc391b695.png"},{"id":61419299,"identity":"8a1bbc8c-1504-4a2d-8733-b9d837f40d60","added_by":"auto","created_at":"2024-07-30 13:34:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80839,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4819708/v1/247cd34befb3aa09a9c46390.png"},{"id":61419298,"identity":"5ee54214-137e-495a-bfcb-31296f3fff64","added_by":"auto","created_at":"2024-07-30 13:34:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":55489,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4819708/v1/65fecbc7b1c0e4259c998493.png"},{"id":61420000,"identity":"f9b74353-58e2-4696-b89d-583ff45c6888","added_by":"auto","created_at":"2024-07-30 13:42:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":954342,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4819708/v1/4fdf2a2d-c202-44d5-9650-0bd3067d5e96.pdf"}],"financialInterests":"\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eAppendix not available with this version.\u003c/p\u003e","formattedTitle":"\u003cp\u003eModulating the value of positive feedback does not influence expectation change in major depression – What can be learned from a failed replication?\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eExpectations have been defined as beliefs about the likelihood of future events or experiences (Panitz et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The ability to adjust expectations in response to new experiences is crucial for mental health. Conversely, a lack of this ability is considered a core feature of many mental disorders (Rief \u0026amp; Joormann, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Especially in people with major depressive disorder (MDD), research has provided evidence for a lack of updating negative expectations in response to novel positive information (for a review, see Kube, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). As such, several studies examining clinical (Kube, Glombiewski, et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), subclinical (Kube et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and non-clinical samples (Kube \u0026amp; Glombiewski, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, 2022) found depressive symptoms to be related to a reduced adjustment of negative performance expectations in response to positive performance feedback. In addition, depression has been shown to be associated with a reduced revision of negative interpretations of ambiguous interpersonal situations in response to novel positive information (Deng et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Everaert et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo account for these problems and facilitate experiential learning in therapy, it is crucial to elucidate the mechanisms underlying deficient expectation update in depression (Rief et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Recent evidence suggests that, in addition to interpretation bias (Deng et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Everaert et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), memory bias (Marchetti et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), attention bias (Keller et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and other cognitive factors, \"cognitive immunization\" might be one such mechanism. Cognitive immunization is referred to as the post-hoc devaluation of expectation-disconfirming experiences through defensive cognitive strategies (Kube et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). For example, the value of an unexpectedly positive experience, such as passing an exam, might be questioned post-hoc by thinking, \u0026ldquo;This was a particularly easy exam \u0026ndash; anyone could have passed it\u0026rdquo;. As a result, the original expectation (e.g., \u0026ldquo;I will fail\u0026rdquo;) is maintained.\u003c/p\u003e \u003cp\u003eIn line with this suggestion, research has shown that such thinking contributes to the persistence of negative expectations despite positive disconfirming evidence (Kube, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Specifically, the experimental modulation of cognitive immunization (promoting vs. inhibiting it) in a subclinical student sample led to significant differences in the adjustment of performance expectations following positive feedback (Kube, Rief, et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Similarly, in a clinical sample of patient with MDD, the inhibition of cognitive immunization boosted the update of negative performance expectations in response to positive performance feedback (Kube, Glombiewski, et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, little is known about how cognitive immunization relates to other cognitive factors and whether it is really a distinct cognitive process. To our knowledge, only one recent study looked into the relationship between cognitive immunization and another well-known cognitive bias, that is, interpretation bias. In that study using a healthy student sample (partly with elevated depressive symptoms), there was no correlation between cognitive immunization and interpretation bias (W\u0026uuml;rtz et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAims and hypotheses\u003c/h3\u003e\n\u003cp\u003eOur study had two main objectives: first, to replicate the results of Kube, Rief, et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) regarding the influence of cognitive immunization on expectation update; and second, to take into account other factors that could potentially influence expectation update, namely, interpretation and memory.\u003c/p\u003e \u003cp\u003eTo pursue the first goal, we used an experimental modulation protocol, in which the engagement in cognitive immunization was promoted in one condition (immunization promotion group\u0026thinsp;=\u0026thinsp;IPG), whereas it was inhibited in another one (immunization inhibition group\u0026thinsp;=\u0026thinsp;IIG). In addition, there were two control groups: one control group that received no manipulation whatsoever (no-instruction control group (NCG), and a distraction control group (DCG) that allowed us to test whether the content of the cognitive immunization manipulation made a real difference in expectation update, or whether the interruption of the procedure by any instruction could account for possible differences in expectation update. Our key hypothesis was that the IIG would show more expectation update than the IPG and the two control groups. In addition, we hypothesized that the IPG would show less expectation update than the two control groups. In terms of a manipulation check, we hypothesized that the IIG would report less cognitive immunization than the IPG and the two control groups. Relatedly, we hypothesized that the IPG would report more cognitive immunization than the two control groups.\u003c/p\u003e \u003cp\u003eRegarding the second goal, we hypothesized that the four experimental groups will not differ in their interpretation of the feedback and in their recall of it.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was approved by the local ethics committee (reference number: 2019-16k) and was conducted in accordance with ethical standards (1964 Declaration of Helsinki and its later amendments). All participants gave informed consent and were treated in accordance with the ethical guidelines of the German Psychological Society. The study was preregistered at aspredicted.org (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://aspredicted.org/CNC_RLF\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants\u003c/h2\u003e\n \u003cp\u003eFor the a-priori power analysis, we assumed a medium effect size, based on previous research on the modulation of cognitive immunization (Kube, Glombiewski, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Accordingly, the a-priori power analysis using G*Power for a repeated measures ANOVA (expected \u0026eta;\u003csub\u003ep\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.080; Power\u0026thinsp;=\u0026thinsp;.80; \u0026alpha;\u0026thinsp;=\u0026thinsp;.05; numerator df: 3) indicated a minimum sample size of 131.\u003c/p\u003e\n \u003cp\u003eParticipants were patients with major depression that were recruited at a German psychosomatic inpatient hospital, where they received non-manualized cognitive behavioral therapy for depression. The study was labelled as a study to investigate the influence of current mood on performance. Inclusion criteria were: current diagnosis of MDD as ascertained by a diagnostic interview; age of at least 18 years; and sufficient German language skills. Participants were excluded if they had participated in a previous study using a similar paradigm or if they correctly guessed the real purpose of the study after completion. Participants were diagnosed by trained master students of clinical psychology using semi-structured clinical interview (Klein et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). As part of the diagnostic interview, it was determined whether the participants met the DSM-5 criteria of a persistent depressive disorder (PDD) or non-persistent MDD. A systematic investigation into how episodic and persistent depressive disorder differ in terms of expectation update, cognitive immunization, and other cognitive aspects, will be reported elsewhere. Participants received 15 EUR as a financial compensation for their participation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedure\u003c/h2\u003e\n \u003cp\u003eThe present study used a well-established false feedback paradigm to investigate change in performance expectations in depression (Kube et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e). Data were collected between November 2021 and January 2023. First, the diagnostic interview was conducted. If the inclusion criteria were met, participants next completed the study in a standard laboratory room at the hospital. Data were entered using the survey platform soscisurvey.de. All measures were completed in German language. Figure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the study procedure.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eInduction of negative baseline expectations.\u003c/strong\u003e Participants were informed that they would have to take a very difficult performance test with which they are unfamiliar. The goal was to lower participants\u0026rsquo; initial performance expectations. Subsequently, we asked participants to indicate their initial performance expectations.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance test.\u003c/strong\u003e Participants completed the \u003cstrong\u003eTE\u003c/strong\u003est of \u003cstrong\u003eEM\u003c/strong\u003eotional \u003cstrong\u003eINT\u003c/strong\u003eelligence (TEMINT; Schmidt-Atzert \u0026amp; Buehner (\u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e). In the TEMINT, the participants\u0026rsquo; task is to empathize with other people and estimate what emotions they felt in certain situations. To this end, participants are provided with 12 emotionally relevant situations that other people experienced (e.g. female dental assistant, age 23): \u0026ldquo;I was about to give birth to my first child\u0026rdquo;). For each of the 12 situations, participants indicate the extent to which the person described in the situation felt certain emotions (e.g., anger, sadness, pride). The TEMINT has several advantages that make it suitable for the paradigm: For instance, it is difficult for participants to evaluate their own performance, which is important for the manipulated performance feedback to appear credible. Furthermore, depression is unrelated to performance deficits in this test (Kube et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Participants\u0026rsquo; actual performance in this test was not relevant to the research question of the present study and is therefore not examined further.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePerformance feedback.\u003c/strong\u003e After completing the TEMINT, participants received manipulated feedback. According to this feedback, participants had solved the majority of the tasks from the test correctly. In addition, as in previous studies (Kube, Rief, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e), participants were fed back that they are among the top 15% of all people who worked on this test. This feedback aimed to disconfirm initial negative performance expectations.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eExperimental conditions.\u003c/strong\u003e Following the performance feedback, participants from the IPG were presented a text in which it was stated that the performance test they just completed has been shown to produce unreliable results and has been shown to be unrelated to any real-world outcomes. This manipulation was supposed to enhance people\u0026rsquo;s propensity to ignore the positive performance feedback and sustain their initial performance expectations. Participants from the IIG were presented a text of equal length and style, in which they were informed that the performance test they completed has been found to be highly reliable and predictive of a number of outcomes of people\u0026rsquo;s personal and professional life. More specifically, participants were informed that people who perform well on the TEMINT (and thus are highly competent in assessing other people\u0026rsquo;s emotions) often have more satisfying relationships and more professional success. This manipulation was intended to prevent participants from devaluing the positive performance feedback and thereby to boost expectation update. In the DCG, participants completed a well-established distraction task of 90 sec length, after receiving the performance feedback. Participants were asked to vividly imagine different scenarios (e.g. A ship crossing the Atlantic) (Nolen-Hoksema \u0026amp; Morrow, \u003cspan class=\"CitationRef\"\u003e1933\u003c/span\u003e). In the NCG, the study was paused for 90 sec. After the experimental manipulations, we asked participants to indicate their performance expectation to succeed in similar tests in the future and assessed cognitive immunization strategies, interpretation and memory.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up measures and debriefing.\u003c/strong\u003e After completing the paradigm, several follow-up questionnaires were administered to assess socio-demographics and depressive symptoms. Finally, the participants were informed about the actual purpose of the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eMeasures\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eChanges in expectations.\u003c/strong\u003e We assessed task-specific and generalized expectations with two scales, each comprising two items. For the wording of the items see (Kube, Rief, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). All items were rated on a seven-point Likert scale ranging from (1) \u0026ldquo;I totally disagree\u0026rdquo; to (7) \u0026ldquo;I totally agree\u0026rdquo;. The total score for both the task-specific and the generalized expectations ranges from 2 to 14. Internal consistency of the generalized expectations scale was \u0026alpha;\u0026thinsp;=\u0026thinsp;.83 before the test and \u0026alpha;\u0026thinsp;=\u0026thinsp;.66 after feedback. For the task-specific expectations scale, internal consistency was \u0026alpha;\u0026thinsp;=\u0026thinsp;.81 before the test and \u0026alpha;\u0026thinsp;=\u0026thinsp;.76 after feedback. As in previous studies (Kube, Glombiewski, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e; Kube, Rief, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e), we pre-defined pre to post changes in generalized expectations as the primary outcome, and the update of task-specific expectations as the secondary outcome.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive Immunization.\u003c/strong\u003e We measured cognitive immunization using the Cognitive Immunization after Performance Feedback (CIPF) Scale. The scale has shown good psychometric properties in previous studies and comprises six items. Two items assess the extent to which participants question the credibility of the feedback. Two items assess the relevance of the feedback. The last two items assess whether participants see their feedback in the TEMINT as a rather untypical result for their personal performance assessment. For the exact wording, see (Kube, Glombiewski, et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Each item was rated on a seven-point Likert scale ranging from (1) \u0026ldquo;I totally disagree\u0026rdquo; to (7) \u0026ldquo;I totally agree\u0026rdquo;. Thus, the total score of the CIPF scale ranges from 6 to 42. Higher values reflect a greater engagement in cognitive immunization strategies. Internal consistency of the six-item CIPF scale was \u0026alpha;\u0026thinsp;=\u0026thinsp;.79. The CIPF-score was significantly correlated with change in generalized (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.151, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.035) and task-specific (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.151, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.035) expectations.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMemory.\u003c/strong\u003e To assess memory performance, participants were asked to free-recall their test result.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation.\u003c/strong\u003e To assess how participants interpreted the performance feedback, they were asked to indicate whether they perceived their test result as \u0026ldquo;clearly above average\u0026rdquo;, \u0026ldquo;slightly above average\u0026rdquo;, \u0026ldquo;average\u0026rdquo;, \u0026ldquo;slightly below average\u0026rdquo; or \u0026ldquo;clearly below average\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDepressive Symptoms.\u003c/strong\u003e We assessed depressive symptoms using the second edition of the Beck Depression Inventory (BDI- II; Beck et al., \u003cspan class=\"CitationRef\"\u003e1996\u003c/span\u003e). The BDI-II compromises 21 items with a 4-point scale ranging from 0 to 3. The sum score ranges between 0 and 63, and lower values indicate fewer depressive symptoms. Internal consistency of the BDI-II was \u0026alpha;\u0026thinsp;=\u0026thinsp;.91.\u003c/p\u003e\n \u003cp\u003eFurthermore, we assessed dispositional optimism and sociodemographic basic variables, as detailed in the supplements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eWe conducted data screening according to (Tabachnik \u0026amp; Fidell (\u003cspan class=\"CitationRef\"\u003e2014\u003c/span\u003e) and tested the assumptions of analyses of variance (ANOVA). We excluded participants deviating\u0026thinsp;\u0026gt;\u0026thinsp;3 standard errors from the mean as outliers. This is in line with the recommendations by (Stevens, \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e) and ensures the analysis is not influenced by highly influential or errant data points.\u003c/p\u003e\n \u003cp\u003eFor the main analysis, we conducted a 2 (Time: pre vs. post feedback) \u0026times; 4 (Condition: immunization promotion vs. immunization inhibition vs. attention control group vs. no task control group) mixed ANOVA, with the generalized performance expectations as the dependent variable. To examine group differences in expectation update, the analysis of most interest is the interaction between the factors Time and Condition. Same applies to task specific expectations as the secondary outcome. As a manipulation check, possible differences between conditions were examined in a one factorial ANOVA with the CIPF total scores as the dependent variable. Type-1 error levels were set at 5% (two-tailed). All analyses were conducted using IBM SPSS Statistics Version 29.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSample Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmunization \u003c/p\u003e \u003cp\u003ePromotion group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImmunization \u003c/p\u003e \u003cp\u003eInhibition group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo-task \u003c/p\u003e \u003cp\u003econtrol group \u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDistraction control group\u003c/p\u003e \u003cp\u003e (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years, \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.7 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.6 (11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (30.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (36,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (41,7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (69.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (63,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (58,3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level, \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo educational degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (63.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment status, \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-time working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (52.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePart-time working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePensioners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisabled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBDI-II scores, \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.1 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.3 (11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis, \u003cem\u003eN\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-persistent MDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (61.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (52.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (47.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote. M\u003c/em\u003e, mean; \u003cem\u003eSD\u003c/em\u003e, standard deviation; \u003cem\u003eN\u003c/em\u003e, number; BDI-II, Beck Depression Inventory II; MDD, Major depressive disorder; PDD, Persistent depressive disorder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e In total, we recruited 179 participants. Of these, 28 participants were excluded because they did not meet the criteria of MDD. Another 4 participants were excluded because they correctly guessed the real purpose of the study. Two participants were excluded because they had taken part in a previous study of our research group using the same paradigm. Additionally, 4 participants were excluded as they did not want to complete the study for the following reasons: concerns about data safety (n\u0026thinsp;=\u0026thinsp;1), difficulty concentrating (n\u0026thinsp;=\u0026thinsp;2), fire alarm (n\u0026thinsp;=\u0026thinsp;1). Another 2 participants were identified as statistical outliers (\u0026gt;\u0026thinsp;3 SD above/below the mean) and were therefore excluded. Thus, subsequent analyses are based on data from 139 participants.\u003c/p\u003e \u003cp\u003eOf these, 75 people met the criteria of PDD, while 64 people suffered from non-persistent MDD. In contrast to Kube et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), depressive symptom burden was severe in the current sample, as indicated by a BDI-II sum score of \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;29.8 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;10.8, range\u0026thinsp;=\u0026thinsp;10\u0026ndash;57). Also, our participants were older, \u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;43.9 years old (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14.8, range 18\u0026ndash;75) and more diverse in their educational degrees (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Comparable to Kube et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), 63.3% of the sample identified themselves as female and 97.1% stated German as their native language. Sociodemographic characteristics are presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. According to recommendation of de Boer et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) we did not check for baseline differences between groups, further sample characteristics are detailed in the Supplements (table A.1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eManipulation Check: Differences in cognitive Immunization\u003c/h2\u003e \u003cp\u003eCognitive immunization significantly differed between groups, \u003cem\u003eF\u003c/em\u003e (3, 135)\u0026thinsp;=\u0026thinsp;5.49; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.001; η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.109; 95%CI [.019, .198]. To further examine group differences, we conducted Bonferroni-corrected pairwise comparisons. As expected, the IIG (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19.97; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;6.82) reported significantly less cognitive immunization (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.040; \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.67; 95%-CI [0.18\u0026ndash;1.15]) than the NCG (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24,82; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.81) and significantly less cognitive immunization (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.85; 95%CI [0.36 \u0026minus;\u0026thinsp;.1.33]) than the DCG (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;26.17; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.49). The NCG and the DCG did not significantly differ (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.999), as expected. Contrary to the rationale of the manipulation, the IPG (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21.50; \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.03) did not significantly differ from the NCG (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.388), DCG (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.050), and the IIG (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.999). Thus, the manipulation was only partly successful: While the IIG lowered the engagement in cognitive immunization as compared to the control groups as hypothesized, the IPC was not successful in increasing participants\u0026rsquo; engagement in cognitive immunization (see Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMain Analysis: Changes in expectations\u003c/h2\u003e \u003cp\u003eTo our surprise, the four groups did not significantly differ in the extent to which they updated their generalized expectations, as indicated by a non-significant Time by Condition interaction, \u003cem\u003eF\u003c/em\u003e (3, 135)\u0026thinsp;=\u0026thinsp;0.57; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.637; η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.004; 95%CI [0, .051]. Overall, participants updated their generalized expectations in a positive direction, as indicated by a significant main effect of Time, \u003cem\u003eF\u003c/em\u003e (1, 135)\u0026thinsp;=\u0026thinsp;24.67; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.154; 95%CI [.071, .245]. As expected, the main effect of Condition was not significant, \u003cem\u003eF\u003c/em\u003e (3, 135)\u0026thinsp;=\u0026thinsp;1.35; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.260; η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.029; 95%CI [0, .086]. The same pattern of results was found for task specific expectations (see supplements). Thus, differences in cognitive immunization were not translated into differences in expectation update (see Fig.\u0026nbsp;3). Descriptive statistics of generalized expectations, task specific expectations, and CIPF ratings are detailed in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAdditional Analyses\u003c/h2\u003e \u003cp\u003eRegarding the influence of other cognitive factors, the groups did not significantly differ in their interpretation of the feedback, \u003cem\u003eF\u003c/em\u003e (3,135)\u0026thinsp;=\u0026thinsp;2.19; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.091, η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.046; 95%CI [0, .114] and there was no significant correlation of interpretation and generalized expectation update (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.123; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.149), as expected. Similarly, the groups did not differ in the height of their memory error, \u003cem\u003eF\u003c/em\u003e (3, 135)\u0026thinsp;=\u0026thinsp;1.61; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.190; and η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.035; 95%CI [0, .095] and there was no significant correlation of memory error and generalized expectation update (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.078; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.182). Cognitive immunization did significantly correlate with a more negative interpretation of the feedback (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.254; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003). Cognitive immunization was not significantly correlated with memory error (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.113; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.185).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpectation and cognitive Immunization rating of the four experimental groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmunization \u003c/p\u003e \u003cp\u003ePromotion group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImmunization \u003c/p\u003e \u003cp\u003eInhibition group (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo-task \u003c/p\u003e \u003cp\u003econtrol group \u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDistraction control group\u003c/p\u003e \u003cp\u003e (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized expectation, \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.62 (2.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.14 (2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.42 (2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.42 (2.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.82 (3.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.56 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.00 (2.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.14 (2.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTask-specific expectation, \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.97 (2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.78 (2.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.06 (3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.44 (3.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.24 (2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.25 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.58 (2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.53 (2.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIPF scale. \u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.50 (7.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.97 (6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.82 (7.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.17 (7.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote. M\u003c/em\u003e. mean; \u003cem\u003eSD\u003c/em\u003e. standard deviation; CIPF scale. Cognitive Immunization after Performance Feedback Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSymptom severity was significantly correlated with more engagement in cognitive immunization (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.176; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.019) and more negative baseline (generalized) expectations (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.29; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), but not with less change of generalized expectations (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.100; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.120).\u003c/p\u003e \u003cp\u003eDue to the standardized (i.e., non-personalized) nature of the feedback (\u0026ldquo;you are among the best 15%\u0026rdquo;), it conveyed larger prediction errors for people with low baseline expectations, and larger prediction errors naturally result in a greater adjustment of expectations (Rescorla \u0026amp; Wagner, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1972\u003c/span\u003e). Accordingly, we reran the main analysis with baseline expectations as a covariate. As the time by condition interaction remained insignificant, \u003cem\u003eF\u003c/em\u003e (3, 135)\u0026thinsp;=\u0026thinsp;1.277, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.285, η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;.046; 95%CI [0, .114], differences in baseline expectations can be ruled out as a significant confounding factor. Since depressive symptoms were related to more negative baseline expectations, the resulting larger prediction errors could have suppressed a relationship between depressive symptoms and expectation update. Therefore, we also computed a partial correlation between depressive symptoms and expectation update, while controlling for baseline expectations, which was significant (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.321; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), indicating that higher depressive symptoms were associated with less expectation update.\u003c/p\u003e \u003cp\u003eTo generate additional hypotheses for the failure of the manipulation, we conducted several additional exploratory analyses. As outlined in the supplements, these analyses did not reveal any covariate that could account for the non-significant group differences in expectation update.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to replicate that cognitive immunization modulates expectation update in depression, and to explore the role of other potentially relevant factors (interpretation, memory). The manipulation check indicated that the manipulation of cognitive immunization was only partly successful: while the IIG reported less cognitive immunization than the two control groups, as intended, the IPG did not differ from the two control groups in cognitive immunization, although cognitive immunization was intended to be increased in this condition. The manipulation therefore seems to have partially failed. Furthermore, even the successfully lowered engagement in cognitive immunization in the IIG was not reflected by significant group differences in expectation update. Thus, the present study failed to replicate that the modulation of cognitive immunization leads to differences in expectation update in depression (Kube, Rief, et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). A number of reasons might account for this failure.\u003c/p\u003e \u003cp\u003eIn contrast to (Kube, Rief, et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), who examined a sub-clinically depressed (BDI-II\u0026thinsp;\u0026gt;\u0026thinsp;9) student sample, the current study used an inpatient clinical sample with relatively high symptom burden and diverse educational degrees. These important sample differences could account for the failure of the manipulation as the written manipulation texts were quite complex and might have been too difficult to understand for a severely impaired participant. More specifically, the manipulation text focused quite heavily on the good vs. bad criterion validity of the TEMIT performance test, which may have required deductive reasoning to understand its implications for the participants. On the other hand, it should be noted that the same manipulation text was successfully used in one experimental condition of another previous study with a similarly impaired clinical sample to inhibit cognitive immunization and promote expectation update (Kube, Rief, et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother possible explanation refers to the fact that in the current study we conducted a diagnostic interview before participants worked on the performance test. This interview, which was perceived as pleasant by many patients, might have reduced negative affect, which could have resulted in greater openness to integrating unexpectedly positive performance feedback, as suggested by previous research (Kube et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Kube \u0026amp; Glombiewski, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eW\u0026uuml;rtz and colleagues (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) found that a lack of group differences was most likely attributable to regression to the mean and depressive symptoms being associated with less positive baseline expectations, which leave more room for an increase of positive expectations. In our study, we also found a small correlation of baseline expectations and depressive symptoms, However, as controlling for baseline expectations did not change the results in our study, these factors do not seem to make a difference in our case.\u003c/p\u003e \u003cp\u003eFurther possible explanations concern the characteristics of the manipulation. First the manipulation was presented subsequently to the presentation of the feedback. If immunization was an automated process immediately following expectation violation, the manipulation might have been carried out too late to influence it. Second, the manipulation consisted of a scientific-factual argumentation presented as a text. As research on open label placebo, as well as on therapy expectations, suggests that the warmth of a presenter is key to the effectiveness of such a rationale (Gaab et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Seewald \u0026amp; Rief, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), it is possible that including a warm presenter would have enhanced the effectiveness of our manipulation.\u003c/p\u003e \u003cp\u003eBeyond that, it could be argued that labelling the test as invalid makes the feedback less relevant for the self-concept and - as a paradoxical consequence - easier to integrate. This would also fit in with the finding that shows that feedback that is too positive is less integrable (Kube et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; W\u0026uuml;rtz et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Nevertheless, this explanation is unlikely to account for the failed replication, as otherwise labelling the test as invalid would also have to lead to a higher integration of the feedback.\u003c/p\u003e \u003cp\u003eIn terms of the feedback that was used in the present study, these findings could very well be relevant. As they show that moderately positive feedback (\"you are among the best 15%\") leads to the strongest change in expectations and the lowest degree of cognitive immunization (Kube et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; W\u0026uuml;rtz et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Thus, more extreme positive feedback (\u0026ldquo;you are among the best 1%\u0026rdquo;) could be more suitable to modulate cognitive immunization. However, this does not explain the discrepancy with Kube, Rief, and colleagues (2019), but as detailed out before the sample used in this previous study may had less difficulties in understanding the manipulation, which may be why cognitive manipulation was manipulated successfully despite the moderately positive feedback.\u003c/p\u003e \u003cp\u003eOverall, participants showed a positive expectation update. This may contradict the results from previous research showing that depression is related to little expectation update in response to positive information (as reviewed by Kube, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, since there was no other population as a control sample, this positive update is difficult to interpret regarding its magnitude, and it could be just a measurement repetition effect.\u003c/p\u003e \u003cp\u003eFinally, replication of empirical social science results is - due to possibly high false failure rates, even in well powered samples- nothing that can be automatically expected, and non-replication in one trial does not automatically imply that the effect is not robust. (Schauer \u0026amp; Hedges, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Stanley \u0026amp; Spence, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). On the other hand, the robustness of the effect can only be evaluated in the long run and therefore further research is needed.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths, Limitations and future directions\u003c/h2\u003e \u003cp\u003eStrengths of our work can be seen in the sufficiently powered clinical sample; the use of a previously validated paradigm; the use of two control groups; the conduction of manipulation checks; the analysis of cognitive immunization in relation to other cognitive factors; and the pre-registration. Notwithstanding these merits, the present studies also have limitations that need to be considered.\u003c/p\u003e \u003cp\u003eA major limitation is that we used quite complex manipulation texts and did not check whether these were comprehended correctly. Thus, we cannot clarify whether the manipulation failed because the participants did not understand the relatively complex wording and content. The fact, that the manipulation partially failed speaks to this possibility. Additionally, the manipulation texts focused only on one immunization strategy (i.e., questioning the validity of expectation-disconfirming information). Therefore, future research may use simpler wording, focus on additional immunization strategies (e.g., considering new evidence to be an exception), and check whether the manipulation is understood correctly. Presenting the manipulation as a video instead of a text may also improve comprehensibility. Moreover, we did not control for participants\u0026rsquo; state affect and therefore cannot rule out whether the diagnostic interview beforehand induced positive affect and facilitated the expectation update. A further limitation pertains to the TEMINT, which might not have been relevant enough to participants and thus have led to limited engagement with the feedback and the subsequent manipulations. Finally, the assessment of expectations via explicit questions using numeric rating scales can be questioned as method to assess expectation change.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study failed to replicate that cognitive immunization modulates expectation update in a sufficiently powered clinical sample of patients with MDD. Only the immunization inhibition group reported the expected reduced levels of cognitive immunization, whereas the immunization promotion group did not differ from the control groups. Therefore, our manipulation failed at least partly and future research may need to use other manipulations of cognitive immunization that are more powerful and easier to understand. Finally, the robustness of the effect of cognitive immunization on expectation update can only be evaluated in the long run and therefore further research is needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter careful consideration, we have decided to make the data available only on request. This is in line with the DFG's recommendations, as the place of data collection is public and the data is therefore particularly sensitive\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAppendix A. Supplementary data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary data to this article can be found online at\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBeck, A. T., Steer, R. A., Ball, R., \u0026amp; Ranieri, W. F. (1996). 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The Role of the Therapist\u0026rsquo;s Warmth and Competence. \u003cem\u003eClinical Psychological Science\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 149\u0026ndash;163. https://doi.org/10.1177/21677026221094331\u003c/li\u003e\n \u003cli\u003eStanley, D. J., \u0026amp; Spence, J. R. (2014). Expectations for Replications: Are Yours Realistic? \u003cem\u003ePerspectives on Psychological Science\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(3), 305\u0026ndash;318. https://doi.org/10.1177/1745691614528518\u003c/li\u003e\n \u003cli\u003eStevens, J. (2002). \u003cem\u003eApplied Multivariate Statistics for the Social Sciences,\u003c/em\u003e (2nd ed.). Erlbaum, Lawrence.\u003c/li\u003e\n \u003cli\u003eTabachnik, B. G., \u0026amp; Fidell, L. S. (2014). \u003cem\u003eUsing multivariate statistics\u003c/em\u003e (6th ed.). Pearson.\u003c/li\u003e\n \u003cli\u003eW\u0026uuml;rtz, F., Kube, T., Woud, M. L., Margraf, J., \u0026amp; Blackwell, S. E. (2024). Reduced Belief Updating in the Context of Depressive Symptoms: An Investigation of the Associations with Interpretation Biases and Self-Evaluation. \u003cem\u003eCognitive Therapy and Research\u003c/em\u003e. https://doi.org/10.1007/s10608-023-10454-w\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"152ba0b2-d6ca-458c-aea9-f84b5340195f","identifier":"10.13039/501100001659","name":"Deutsche Forschungsgemeinschaft","awardNumber":"grant numbers KU 3955/3-1 and RI574/31-1 awarded to TK and WR","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Philipp University of Marburg","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Belief updating, Cognitive immunization, Cognitive factors, Expectation, Depression","lastPublishedDoi":"10.21203/rs.3.rs-4819708/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4819708/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDepression is related to a reduced update of negative expectations in response to positive information. Here, we aimed to replicate that cognitive immunization (a cognitive devaluation of expectation-disconfirming information) modulates expectation updating in depression. Further, we examined how other cognitive factors (i.e., memory, interpretation) relate to cognitive immunization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eWe examined 139 inpatients (18-75 years) diagnosed with major depression. Participants completed a false-feedback task, in which they received unexpectedly positive standardized feedback. Cognitive immunization was manipulated via text that framed the feedback as particularly valid vs. invalid, relative to a distraction-control group and a no-instruction control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere were no significant group differences in expectation updating. One interpretation questions the effect of the manipulation of cognitive immunization, which was not successful according to the manipulation check. The experimental conditions did not differ in their memory or interpretation of the feedback. However, negative interpretations were associated with elevated cognitive immunization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Our study failed to replicate that cognitive immunization modulates expectation updating in depression - most likely due to the failure of the cognitive immunization manipulation. Future research may need to use a stronger and easier to understand manipulation (e.g., video instead of text; simpler wording) to modulate cognitive immunization successfully.\u003c/p\u003e","manuscriptTitle":"Modulating the value of positive feedback does not influence expectation change in major depression – What can be learned from a failed replication?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-30 13:34:22","doi":"10.21203/rs.3.rs-4819708/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52c1923a-78a1-4b77-b8cd-13b06834cad0","owner":[],"postedDate":"July 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-30T13:34:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-30 13:34:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4819708","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4819708","identity":"rs-4819708","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}