Depression greatly affects sexuality. Theoretical and empirical evidence account for the existence of attention bias to sex-related stimuli. This attention bias might be impaired in depression, resulting in sexual problems. A sample of 13 patients with depression and 13 matched healthy controls were tested using the dot-probe and picture recognition task to measure attention to erotic images. No difference in attention to sex-related stimuli (ω2 = 0, p = 0.22) and in memory bias (ω2 = 0, p = 0.72) was found between the two groups. Explorative analyses were conducted to identify the sexual content-induced delay effect in the data, assess variability differences, and compare trial-level bias score-based indexes between groups. Across all analyses, there was little evidence for depression affecting sexual-related cognitive processing, and even this might be explained by other means. Our results suggest that restrained attention is probably not the main factor behind sexual problems in depression.

Faculty of Humanities Charles University 182 00 Prague Czech Republic

Laboratory of Evolutionary Sexology and Psychopathology National Institute of Mental Health 250 67 Klecany Czech Republic

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Liu Q., Zhang Y., Wang J., Li S., Cheng Y., Guo J., Zhu Z. Erectile dysfunction and depression: A systematic review and meta-analysis. J. Sex. Med. 2018;15:1073–1082. doi: 10.1016/j.jsxm.2018.05.016. PubMed DOI

Atlantis E., Sullivan T. Bidirectional association between depression and sexual dysfunction: A systematic review and meta-analysis. J. Sex. Med. 2012;9:1497–1507. doi: 10.1111/j.1743-6109.2012.02709.x. PubMed DOI

Frohlich P., Meston C. Sexual functioning and self-reported depressive symptoms among college women. J. Sex Res. 2002;39:321–325. doi: 10.1080/00224490209552156. PubMed DOI

Bancroft J., Janssen E., Strong D., Carnes L., Vukadinovic Z., Long J.S. The relation between mood and sexuality in heterosexual men. Arch. Sex. Behav. 2003;32:217–230. doi: 10.1023/A:1023409516739. PubMed DOI

Bancroft J., Janssen E., Strong D., Vukadinovic Z. The relation between mood and sexuality in gay men. Arch. Sex. Behav. 2003;32:231–242. doi: 10.1023/A:1023461500810. PubMed DOI

Beck A.T. Cognitive models of depression. In: Leahy R.L., Dowd E.T., editors. Clinical Advances in Cognitive Psychotherapy: Theory and Application. Volume 14. Springer; Berlin/Heidelberg, Germany: 2002. pp. 29–61.

Hallion L.S., Ruscio A.M. A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychol. Bull. 2011;137:940. doi: 10.1037/a0024355. PubMed DOI

Peckham A.D., McHugh R.K., Otto M.W. A meta-analysis of the magnitude of biased attention in depression. Depress. Anxiety. 2010;27:1135–1142. doi: 10.1002/da.20755. PubMed DOI

Gilbert P. Evolution and depression: Issues and implications. Psychol. Med. 2006;36:287. doi: 10.1017/S0033291705006112. PubMed DOI

Lee R.S., Hermens D.F., Porter M.A., Redoblado-Hodge M.A. A meta-analysis of cognitive deficits in first-episode major depressive disorder. J. Affect. Disord. 2012;140:113–124. doi: 10.1016/j.jad.2011.10.023. PubMed DOI

Friedman N.P., du Pont A., Corley R.P., Hewitt J.K. Longitudinal relations between depressive symptoms and executive functions from adolescence to early adulthood: A twin study. Clin. Psychol. Sci. 2018;6:543–560. doi: 10.1177/2167702618766360. PubMed DOI PMC

Snyder H.R. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychol. Bull. 2013;139:81–132. doi: 10.1037/a0028727. PubMed DOI PMC

Gotlib I.H., Kasch K.L., Traill S., Joormann J., Arnow B.A., Johnson S.L. Coherence and specificity of information-processing biases in depression and social phobia. J. Abnorm. Psychol. 2004;113:386. doi: 10.1037/0021-843X.113.3.386. PubMed DOI

Gilboa E., Gotlib I.H. Cognitive biases and affect persistence in previously dysphoric and never-dysphoric individuals. Cogn. Emot. 1997;11:517–538. doi: 10.1080/026999397379881a. DOI

Shane M.S., Peterson J.B. An evaluation of early and late stage attentional processing of positive and negative information in dysphoria. Cogn. Emot. 2007;21:789–815. doi: 10.1080/02699930600843197. DOI

Aquino J.M., Arnell K.M. Attention and the processing of emotional words: Dissociating effects of arousal. Psychon. Bull. Rev. 2007;14:430–435. doi: 10.3758/BF03194084. PubMed DOI

Feng C., Wang L., Wang N., Gu R., Luo Y.J. The time course of implicit processing of erotic pictures: An event-related potential study. Brain Res. 2012;1489:48–55. doi: 10.1016/j.brainres.2012.10.019. PubMed DOI

Pottage C.L., Schaefer A. Visual attention and emotional memory: Recall of aversive pictures is partially mediated by concurrent task performance. Emotion. 2012;12:33. doi: 10.1037/a0024574. PubMed DOI

Spiering M., Everaerd W. The sexual unconscious. In: Janssen E., editor. The Psychophysiology of Sex. Indiana University Press; Bloomington, IN, USA: 2007. pp. 166–184.

Strahler J., Baranowski A.M., Walter B., Huebner N., Stark R. Attentional bias toward and distractibility by sexual cues: A meta-analytic integration. Neurosci. Biobehav. Rev. 2019;105:276–287. doi: 10.1016/j.neubiorev.2019.07.015. PubMed DOI

Cummins R.G., Gong Z.H., Reichert T. The impact of visual sexual appeals on attention allocation within advertisements: An eye-tracking study. Int. J. Advert. 2020;39:1–25. doi: 10.1080/02650487.2020.1772656. DOI

Dagnino B., Navajas J., Sigman M. Eye fixations indicate men’s preference for female breasts or buttocks. Arch. Sex. Behav. 2012;41:929–937. doi: 10.1007/s10508-012-9945-3. PubMed DOI

Fromberger P., Jordan K., von Herder J., Steinkrauss H., Nemetschek R., Stolpmann G., Müller J.L. Initial orienting towards sexually relevant stimuli: Preliminary evidence from eye movement measures. Arch. Sex. Behav. 2012;41:919–928. doi: 10.1007/s10508-011-9816-3. PubMed DOI PMC

Fromberger P., Jordan K., Steinkrauss H., Von Herder J., Stolpmann G., Kröner-Herwig B., Müller J.L. Eye movements in pedophiles: Automatic and controlled attentional processes while viewing prepubescent stimuli. J. Abnorm. Psychol. 2013;122:587–599. doi: 10.1037/a0030659. PubMed DOI

Morandini J.S., Spence B., Dar-Nimrod I., Lykins A.D. Do bisexuals have a bisexual viewing pattern? Arch. Sex. Behav. 2020;49:489–502. doi: 10.1007/s10508-019-01514-y. PubMed DOI

Doornwaard S.M., van Den Eijnden R.J.J.M., Johnson A., ter Bogt T.F.M. Exposure to sexualized media content and selective attention for sexual cues: An experimental study. Comput. Hum. Behav. 2014;41:357–364. doi: 10.1016/j.chb.2014.10.037. DOI

Kagerer S., Wehrum S., Klucken T., Walter B., Vaitl D., Stark R. Sex attracts: Investigating individual differences in attentional bias to sexual stimuli. PLoS ONE. 2014;9:e107795. PubMed PMC

Mechelmans D.J., Irvine M., Banca P., Porter L., Mitchell S., Mole T.B., Voon V. Enhanced attentional bias towards sexually explicit cues in individuals with and without compulsive sexual behaviours. PLoS ONE. 2014;9:e105476. doi: 10.1371/journal.pone.0105476. PubMed DOI PMC

Novák O., Bártová K., Vagenknecht V., Klapilová K. Attention bias and recognition of sexual images. Front. Psychol. 2020;556071:1–11. doi: 10.3389/fpsyg.2020.556071. PubMed DOI PMC

Geer J.H., Bellard H.S. Sexual content induced delays in unprimed lexical decisions: Gender and context effects. Arch. Sex. Behav. 1996;25:379–395. doi: 10.1007/BF02437581. PubMed DOI

Imhoff R., Barker P., Schmidt A.F. To what extent do erotic images elicit visuospatial versus cognitive attentional processes? Consistent support for a (non-spatial) sexual content-induced delay. Arch. Sex. Behav. 2019;49:531–550. doi: 10.1007/s10508-019-01512-0. PubMed DOI

Everaerd W., Both S., Laan E. The experience of sexual emotions. Annu. Rev. Sex Res. 2006;17:183–199.

Barlow D.H. Causes of sexual dysfunction: The role of anxiety and cognitive interference. J. Consult. Clin. Psychol. 1986;54:140–148. doi: 10.1037/0022-006X.54.2.140. PubMed DOI

de Jong D.C. The role of attention in sexual arousal: Implications for treatment of sexual dysfunction. J. Sex Res. 2009;46:237–248. doi: 10.1080/00224490902747230. PubMed DOI

Bancroft J., Graham C.A., Janssen E., Sanders S.A. The dual control model: Current status and future directions. J. Sex Res. 2009;46:121–142. doi: 10.1080/00224490902747222. PubMed DOI

Prause N., Janssen E., Hetrick W.P. Attention and emotional responses to sexual stimuli and their relationship to sexual desire. Arch. Sex. Behav. 2008;37:934–949. doi: 10.1007/s10508-007-9236-6. PubMed DOI

Janssen E., Vorst H., Finn P., Bancroft J. The sexual inhibition (SIS) and sexual excitation (SES) scales: I. Measuring sexual inhibition and excitation proneness in men. J. Sex Res. 2002;39:114–126. doi: 10.1080/00224490209552130. PubMed DOI

Janssen E., Vorst H., Finn P., Bancroft J. The sexual inhibition (SIS) and sexual excitation (SES) scales: II. Predicting psychophysiological response patterns. J. Sex Res. 2002;39:127–132. doi: 10.1080/00224490209552131. PubMed DOI

World Health Organization (WHO) The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization; Geneva, Switzerland: 1993.

Hayasaka Y., Purgato M., Magni L.R., Ogawa Y., Takeshima N., Cipriani A., Furukawa T.A. Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials. J. Affect. Disord. 2015;180:179–184. doi: 10.1016/j.jad.2015.03.021. PubMed DOI

Serretti A., Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: A meta-analysis. J. Clin. Psychopharmacol. 2009;29:259–266. doi: 10.1097/JCP.0b013e3181a5233f. PubMed DOI

Beck A.T., Steer R.A., Brown G.K. Beck Depression Inventory-II. The Psychological Corporation; San Antonio, TX, USA: 1996.

Ptáček R., Raboch J., Vňuková M., Hlinka J., Anders M. Beckova škála deprese BDI-II—Standardizace a využití v praxi. Ceska. Slov. Psychiatr. 2016;112:270–274.

Carpenter D., Janssen E., Graham C., Vorst H., Wicherts J. Women’s scores on the sexual inhibition/sexual excitation scales (SIS/SES): Gender similarities and differences. J. Sex Res. 2008;45:36–48. doi: 10.1080/00224490701808076. PubMed DOI

Schneider W., Eschman A., Zuccolotto A. E–Prime Version 2.0. Psychology Software Tools Inc.; Pittsburgh, PA, USA: 2002. Computer Software.

Bártová K., Novák O., Weiss P., Klapilová K. Personality traits and sociosexual orientation are related to sexual inhibition and sexual excitation scales: Evidence from the Czech Republic. Pers. Individ. Differ. 2021;171:110468. doi: 10.1016/j.paid.2020.110468. DOI

R Core Team . R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; Vienna, Austria: 2019. Computer Software.

JASP Team . JASP Version 0.11. University of Amsterdam; Amsterdam, The Netherlands: 2019. Computer Software.

Stanislaw H., Todorov N. Calculation of signal detection theory measures. Behav. Res. Methods Instrum. Comput. 1999;31:137–149. doi: 10.3758/BF03207704. PubMed DOI

Ellis P.D. The Essential Guide to Effect Sizes: Statistical Power, Meta-Analysis, and the Interpretation of Research Results. Cambridge University Press; Cambridge, UK: 2010.

Eid M., Gollwitzer M., Schmitt M. Statistik und Forschungsmethoden Lehrbuch. Beltz; Weinheim, Germany: 2011.

Zvielli A., Bernstein A., Koster E.H. Temporal dynamics of attentional bias. Clin. Psychol. Sci. 2015;3:772–788. doi: 10.1177/2167702614551572. DOI

Conaglen H.M., Evans I.M. Pictorial cues and sexual desire: An experimental approach. Arch. Sex. Behav. 2006;35:197–212. doi: 10.1007/s10508-005-9000-8. PubMed DOI

Cleveland W.S., Grosse E., Shyu W.M. Local regression models [chapter 8] In: Chambers J.M., Hastie T.J., editors. Statistical Models. Wadsworth & Brooks/Cole; Pacific Grove, CA, USA: 1992. p. 608.

Dennis-Tiwary T.A., Roy A.K., Denefrio S., Myruski S. Heterogeneity of the anxiety-related attention bias: A review and working model for future research. Clin. Psychol. Sci. 2019;7:879–899. doi: 10.1177/2167702619838474. PubMed DOI PMC

Rupp H.A., Wallen K. Sex differences in response to visual sexual stimuli: A review. Arch. Sex. Behav. 2008;37:206–218. doi: 10.1007/s10508-007-9217-9. PubMed DOI PMC

Snowden R.J., Curl C., Jobbins K., Lavington C., Gray N.S. Automatic direction of spatial attention to male versus female stimuli: A comparison of heterosexual men and women. Arch. Sex. Behav. 2016;45:843–853. doi: 10.1007/s10508-015-0678-y. PubMed DOI PMC