2014. Vol.5, No.1, 15-19
Published Online Janu ary 201 4 in Sci R es (
Comparing the Recall to Pleasant and Unpleasant Face
Pictures in Depressed and Manic Individuals
Mehran Sardaripour
Department of Clinical Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
Received October 24th, 2013; revised November 26th, 2013; accepted December 23rd, 2013
Copyright © 2014 Mehran Sardaripour. This is an open access article distributed under the C reative Commons
Attribution License, which pe rmits unrestricted use, distribu tion, and reproduction in any medium, provided the
original work is properly cited. In accordance of the Creative Commons Attribution License all Copyrights ©
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The main purpose of the present study is to compare the perception of recalling pleasant and unpleasant
face pictures in the case of depressed and manic people. Methodology: The present study is an analysis
based on a comparative type research; the statistical sample is made up of depressed and manic people
(males) referred to LAVASANI Hospital in Tehran City using Beck’s depression questionnaire and a di-
agnostic interview based on (SCID) DSMIV 30 depressed individuals who were selected after the process
of screening. Ranging from moderate to high depression levels (with a cut-off point of 21 and higher),
samples of 30 people with manic and 30 depressed people were compared with 30 healthy individuals. It
should be mentioned that three groups were convergent in terms of age, gender, marital status and educa-
tional level. Then, a test involving computer-based cognitive-neural recall (emotional facial Pictures) was
carried out on the related subjects. Findings: A t test of both independent groups was used to evaluate the
convergence of the groups and multi variable bilateral variance analysis (MANOVA) was used to assess
the pleasant and unpleasant perception of images among three groups. The results of the study showed
that there is a difference among three groups in terms of recalling pleasant and unpleasant faces so that
the depressed group shows a higher level of recall in terms of unpleasant images than the other two
groups, but it indicates little recall of pleasant images in comparison to the other two groups (p < 0/05).
Conclusion: The findings of the present study include some explicit outcomes in relation to the applica-
tion of therapeutic approaches and concentrated educational methods on the amendment of emotional bias
in depressed and manic people.
Keywords: Depression; Manic; Pleasant Face Image; Unpleasant Face Pictures
The process of recognition has an important role in playing
with regard to emotions. Based on the theory of recognition,
emotions determine the cognitive evaluations as to whether or
not emotions are experienced. And, if so, which kinds of emo-
tions are experienced. Consequently, basic recognition is a way
in which we can handle and control these emotional and moral
situations. Biases and deficits in terms of cognitive perform-
ance and the ability to regulate emotion and mood states can
potentially be affected by increasing these disorders in emo-
tions (Joormann, Yoon, & Siemer, 2009). Based on the cogni-
tive theories regarding depression, negative bias in processing
the related information (for example Beck, 1976) is one of the
most crucial traits of depressed people, particularly in terms of
negative attention bias (Murrough, Lacoviello, Neumeister,
Chaney, & Losifescu, 2011). Generally, these kinds of models
suggest that these biases in memory, perception and attention
lead to the survival of the depression. (Kellough, Beevers, Ellis,
& Wells, 2008). In fact, clinical depression may be accompa-
nied by a large number of cognitive disorders such as percep-
tion bias, attention and memory. There may be a negative emo-
tional context and a reduction in terms of the speed and accu-
racy of emotion and cognitive processes, particularly in terms
of executive functions (Chepenik, Cornew & Farah, 2007).
Many stimulants can affect people simultaneously. What people
practically perceive depends not only on the stimulants, but also
depends on the whole processes of cognition reflecting the
tendencies, purposes and personal expectations in a moment. In
other words, cognitive processes (perception, attention, analysis)
have a determining role in this relationship (Atkinson et al.,
1983, translated by Berahani et al., 2008). It is expected that
depressed people are selective attention to negative stimulants.
These kinds of biases play a key role in preserving and con-
tinuing the longevity of the depression (Kellough et al., 2008).
On the one hand, manic people also show disorders in terms of
memory and planning tests, but they are different in terms of
emotional function in comparison to depressed people. “Manic
patients were impaired in their ability to inhibit behavioral re-
sponses and focus attention, but depressed patients were im-
paired in their ability to shift the focus of attention” (Murphy et
al., 1999). Also, an intensified sensitivity is observed in the
behavioral activity system in these people (Johnson, Edge,
Holms, & Carver, 2012). While depressed people usually show
a shift in the focus of attention disorder (Murphy et al., 1999),
they also show intensified sensitivity in their behavioral inhibi-
tory system (Hundt, Nelson-Gray, Kimbr el, Mit chel l, & Kwapil,
2007; Pinto-Meza et al., 2006, quoted of Vergara-Lopez, Lo-
pez-Vergara & Colder, 2012). Generally, depressed people
have a bias to negative stimulants, while manic people have a
bias to positive emotional biases (Murphy et al., 1999). In terms
of neurological function, Amygdale is an essential connective
lobe in terms of recognition and the manner in which the brain
plays a key role in memory, perception and manner (Chepenik,
Cornew, & Farah , 2007). Indeed, the attention bias of depressed
patients is represented by increasing the neurotic response to
the negative emotional demonstrations in the Amygdale lobe.
However, few studies have been carried out in relation to the
reduction of Amygdale activity with regard to positive stimu-
lants. In this sense, Suslow et al. (2010) found that the Amyg-
dale extra-activation to the negative stimulants in depressed
people is related to the negative bias of emotion steps (Cusi,
Nazarov & Holshausen, 2012). Stuhrmann, Suslow, & Dann-
loeski (2011 quoted of Ajilchi & Nejati, 2013) in a review of 20
pieces of research about face processing among depressed peo-
ple, reported abnormalities and disorders in the face of proc-
essing net, indicating that the processing bias related to mood
disorder that connects to the Amygdale, Insula, parahippocam-
pal Gyrus, fusiform, putamen, cingulare and rbitofrontal cortex,
so that the reduction in pre-frontal lobe activity in depression
may be affected by the negative bias in attention and memory
(Beevers et al., 2010; Fales et al., 2008; Koster et al., 2010,
quoted in Capecelatro, 2013). In addition, depressed people
show problem with regard to perceptions of social symptoms
such as negative bias to emotional faces in comparison to health
individuals (Gur, Erwin, Gur, Zwil, Heimberg, & Kraemer,
1992; Bouhuys, Geerts, & Gordijn, 1999). These biases in-
crease with responses, and the neural net lobes are challenged
in processing the emotions, therebye increasing the response of
the Amygdale to the representation of negative appearances in
depressed people in comparison to healthy ones (Suslow et al.,
2010; Viktor et al., 2010, quoted in Ajilchi and Nejati, 2013).
In a study led by Capecelatro et al. (2013), it was shown that
people with more than five years of depression have a higher
application of negative words, and little emotional positive
statements in this regard.
The results of the study indicate that the period of depression
has a direct relationship with negative stimulants in terms of the
recall process. The results of the experimental research indi-
cates that manic symptoms are increasing, so that the risk of
developing the mania along with positive sustainable emotions
even in a negative context, can also happen in this case (Gruber,
2011; Gruber, Johnson, Oveis, & Keltner, 2008; Gruber, Har-
vey, & Purcell 2011, quoted in Dutra et al. forthcoming). The
clinical mania background of people has been reduced in com-
parison to those of healthy ones, due to the social recognition
tasks and their neural activity in the related lobes with the rep-
resentation of others emotions (Kim et al., 2009 quoted in
Dutra et al. forthcoming). Manic people have seen the reduction
in activity in the ventrolateral prefrontal cortex (VLPFC) and
hyper activity in Amygdale in terms of their emotional tasks.
In fact, the reduction in frontal inhibitory activation among
these patients may increase the Amygdale activity in such a
case. While it is modulated in healthy people of course, when
the subjects are motivated due to their determination and the
labeling of these emotional actions (Foland et al., 2008, 2012),
it seems that the extra-activation acts in conjunction with the
mood-related affairs of these people. However, the reduction
activity in the ventrolateral prefrontal cortex is related abnor-
mality with trait-related of their illness (Foland et al., 2012).
The logic of applying pleasant and unpleasant faces in the ap-
pearance of the subjects, the readiness of humans biologically,
the phenomenological emotion of face demonstration, even
unconsciously (Dimberg, Thunberg, & Elmehed, 2000; Falla &
Hamilton, 1998), and the closeness of the face to the real situa-
tions compared with words (Moog & Bradley, 2002) was con-
sidered in this regard. Recent theories about recognition and
emotion suggest that emotional states can cause bias in the
orientation of processing cohesive information with emotional
moods (Reidy & Richard, 1997). Since these biases play a key
role in the continuation of emotional disorders (depression and
mania), the carrying out of the present study not only helps to
determine cognitive abnormalities, but also assists in finding
and amending the application of some approaches in this case.
Also, the accurate evaluation of these negative biases can rep-
resent new approaches in terms of emotional disorders, lead-
ing to the appearance of new therapeutic methods along these
lines. Based on this, and due to the lack of recent studies in this
field, the present study aims at potentially dealing with the
related issu es. Hence, the research hypothesis is as follows:
1) The recall of emotional faces in depressed people is dif-
ferent from that in the case of healthy individuals.
2) The recall of emotional faces in manic people is different
from that in the case of healthy individuals.
3) The recall of emotional faces in manic people is different
from depressed individuals.
The present study is a comparative analytical type of re-
search. Independent variable is mood (group) and dependent
variable is perception of pleasant and unpleasant images. The
present study is a comparative analytical type of research. The
sample used in this study involves males ranging from 20 to 25
year of age who exhibit symptoms of depression and mania
who were referred to LAVASANI Hospital in Tehran City in
2011. The clinical diagnosis was based on unstructured inter-
views matched with the textual criteria and edited in terms of
the fourth diagnostic guidelines and psychiatric disorders statis-
tics (SCID) DSMIV available to psychologists in this regard.
30 depressed patients and another 30 manic patients acted as
the available sample of the research. In addition, another 30
people with no background of psychological abnormalities
were matched in terms of age, gender, marital status and educa-
tional level and were then compared in the research. In the
group with depression and mania, the entry conditions to the
study were subject to the diagnostic criteria of the disorders
matched to (SCID) DSMIV criteria, and also included those
gaining a score of 21 and higher in the Beck’s questionnaire.
They also exhibited a lack of bipolar antecedents. In the healthy
group, the lack of a psychiatric background was considered as
an entry conditions to the study. Data were analyzed by one-
way analysis of variance used SPSS, version 20.
Demographic Features Questionnaire
This questionnaire was prepared by the researcher to deter-
mine the demographic features of the subjects such as age,
gender, marital status and educational level.
Beck Depression Inventory (BDI)
This test was designed by Beck et al., the depressive symp-
toms being measured by this test include emotional symptoms,
and motivational, cognitive, physical and plantar affairs in this
relationship. Beck has reported the reliability of the test at 0.93
using the Spearman-Brown method. This questionnaire con-
tains 21 questions, every one of which has four choices (0, 1, 2,
and 3). The subjects draw a circle around the number showing
their feelings as a suitable response. Fata (1991) reported the
correlation coefficient between the Beck Depression Inventory
and the Hamilton Depression Scale among Iranian subjects -
0.66 in this case (Ajilchi & Nejati, 2013).
Structured Clinical Interview for (SCID) DSM-IV
SCID is a semi structured interview for making the major
DSM-IV Axis diagnoses, this is an interview-based test de-
signed to be easy to facilitate and apply by clinical psycholo-
gists (Spiterz, Williams, Gibbon, & First, 1992).
Many different studies have shown the suitability of the
questionnaire in terms of reliability and validity (Williams,
Gibbon et al., 1992; Martin, Pollack, Bukstein, & Lynch, 2000;
Skre, Onstad, Torgersen, & Kringlen, 1991; Zanarini & Fran-
kenburg, 2001, quoted in Sharifi et al., 2004). In Iran Sharifi et
al. (2004) the authors also indicated that this interview has a
suitable reliability and validity and reported the Kappa Coeffi-
cient to be 0.52 in this case.
Computer-Based Software to Represent the Pleasant and
Unpleasant Stimulants
In this test, 18 pairs of face images demonstrating sad and
happy emotions were extracted using the Nim Stim data bank.
(Tottenham et al., 2009) and were used as a stimulant in this
case. As shown in Figure 1, the images and dots were repre-
sented in two frames of the rectangle with 2 cm from the dis-
play central fixed point. The subject stood 50 cm from the
computer. First, an empty frame and fixation point (+) were
presented for 500 thousands of a second; then, two faces to the
left and right of the fixation point of the display were also pre-
sented for 500 thousands of a second. The subjects were asked
to recall the number of happy and sad faces in this case. The
test was undertaken by the use of a laptop.
The research variables are shown in Table 1 in terms of their
type of separation.
As is shown in Table 1, we can see that the mean recall
process is different between the three groups.
In order to evaluate the significance of these differences, a
single-sided variance analysis was applied. The insignificance
of the Levin test showed the establishment of variances’ as-
similations among three groups; hence, the results of the vari-
ance analysis are represented in this case.
According to the results shown in Table 2, it can be stated
that there is a significant difference between the three groups of
depressed, manic and control cases at the p < 0.05 level.
The results of a Tooki follow-up test are given in Table 3 in
order to determine and specify the establishment of these dif-
Figure 1.
Comoputer based software to represent the pleasant and unpleasent
Table 1.
Descriptive findings related to happy and sad pleasunt and unpleasant
images by groups s eparation.
Type of representation Group Mean Std deviation
Depressed 3.53 0.973
Manic 4.90 1.44
Control 4.73 1.55
Depressed 5.63 1.79
Manic 3.97 1.67
Control 4.50 1.57
Table 2.
One way analysis of variance for pleasunt and unpleasant images.
Type of
representation Source
Sum of
squares Df
Mean of
squares F Sig
group 33.35 2 16.67 9.18 0.001
Within group
158.03 187 1.81
group 43.46 2 2.82 7.70 0.001
within group 245.43 187
Table 3.
Tukey test for defferences between groups in pleasant and unpleasant
Type of
Group 1 Group 2 Mean of
differen ces Std
estimation error
Pleasant D epressed Manic 1.36
Control 1.20* 0.348
Manic Control 0.167 0.348
Unpleasant Depress ed Manic 1.66
Control 1.133
Manic Control 0.533 2.75
According to Table 3, we find out that there is a significant
difference between both groups of depressed and manic and
depressed and control cases in the dimension of pleasant face
recall cases at the p < 0.05 level. However, there is no observed
significant difference between manic and control groups. Also,
there is a significant difference between depressed with manic
and depressed with control groups in terms of the dimension of
the unpleasant face recall process, but there is no found differ-
ence between the manic and the control group.
The findings of the present study show that in the depressed
group, the degree of recall of pleasant emotional faces is low in
comparison to the manic and control groups, and the degree of
recalling unpleasant images is high among the related groups.
This result is coincident with the results obtained by Storman et
al. (2011), Suslow et al. (2010), Modinos et al. (2013), Murphy
et al. (1999) and Viktor et al. (2010) based on depressed peo-
ple’s tendency to favor unpleasant stimulants, and their avoid-
ance of pleasant stimulants. Generally, it is specified that de-
pressed people have emotional biases with regard to negative
stimulants. In fact, they act in relation to their own mood state,
particularly in the case of emotional stimulants. Depressed
people pay a great deal of attention to negative stimulants due
to the low level of their mood. In contrast, manic people show
positive reactions due to their high mood state and, as a result,
they process their affairs more, trying to retain them in their
memory. As was motioned before, the tendencies of both
groups relate to neural processes and brain lobes in terms of
emotional processes. In fact, in both groups, the reduction of
related prefrontal cortex activity and the increase of Amygdale
activity is seen in this case. These changes lead to an activity
among depressed people when they are faced with negative
stimulants and in manic people when they are faced with posi-
tive stimulants. On the other hand, it is obvious that the first
step is subject to the process of bias because attention is the
foundation and basis of the whole cognitive approach, consid-
ering the inventory and entry of the information into the brain
(Arjmandi et al., 2012). It is, of course, defined as a clear con-
centration of the objects and the mind, or a chain of simultane-
ous stimulants (Cohen, 1990, quoted in Arjmandi et al., 2012).
Thus, it seems that the correction of emotional biases regarding
the mood state in the attention step can prevent the next biases
in terms of information processing, perception and saving in the
memory, and then the recall process. On the other hand, this
tendency regarding emotional mood stimulants can be repre-
sented by the motivational system of people. The motivation
appears in different forms due to people’s differences in terms
of emotional and sensitivity reactions (Rothbart & Bates, 2006).
Researchers have shown that depression accompanies a default
in the motivation system leading to weaknesses in the reaction
to positive and intense events (Zinbarg & Yoon, 2008). Fowles
(1994) believes in this relationship that depression is generated
by interaction in terms of two motivation systems the behav-
ioral approach system (BAS) and the behavioral inhibition sys-
tem (BIS). The first system is subject to the sensitivity of moti-
vating the one towards them, while the second one is related to
the disgusting conditions and new stimulants motivating
avoidance in this regard (Gray, 1982). Based on this viewpoint,
the depression feature may be subject to a lack of interest in
experiencing pleasant cases (due to the failure of behavioral
inhibition system activity) and sensitivity to the bothering
events (due to the increase in inhibitory system activity). In
contrast, manic people have problems in terms of their behav-
ioral responses’ inhibition ability; that is, it seems that despite
the existence of depressed people. In terms of a manic person,
the behavioral approach system is reduced. Indeed, depressed
people pay attention to negative stimulants while manic ones
pay attention to the positive stimulants in their events.
The most important point is that in the present study, there is
an observed difference between depressed people and the manic
and control groups in terms of tending towards the recall of
unpleasant stimulants, while pleasant stimulants are preferred
by manic people. However, a difference was found between
manic groups and healthy ones in tending to be able to recall
unpleasant stimulants. Based on the findings of the present
study, manic people show a high tendency towards positive
stimulants in comparison to people in the healthy group. It may
be closely related to signs of manic tendencies in these people.
Maybe the intensity of manic signs could not be evaluated.
Based on this, it is suggested that future studies should be based
on manic patients in terms of their intensity categorization. The
limitation of the statistical sample consisting of only male pa-
tients and one hospital in Tehran, as well as the limitations of
the size of the sample has been considered as limitations of the
present study. It is also recommended that researchers consider
gender comparisons in future research.
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