Major Depressive Disorder: Emerging Evidence for Emotion Context Insensitivity

Given that major depressive disorder (MDD) is essentially a disorder of mood, how does a major mood disturbance influence emotion? Using theory from affective science, in this chapter I first outline two initial hypotheses about how mood disturbance might influence depressed persons\u27 responses to positive and negative emotional stimuli. Second, I review the empirical record, which includes a number of discrepancies that cannot be easily accommodated by these initial hypotheses. To better assimilate these discrepant findings, I outline an alternative theory-based hypothesis concerning emotions in MDD, which I call the emotion context insensitivity (ECI) hypothesis. I consider possible benefits of characterizing depression in terms of ECI and outline remaining areas of ambiguity concerning the ECI hypothesis. Finally, I outline several focal areas for future work designed to increase our understanding of emotional reactivity in MDD and the role that emotion plays in this disorder

Emotions in Depression: What Do We Really Know?

Major depressive disorder is among the most common and costly of all mental health conditions, and in the last 20 years, emotional dysfunction has been increasingly seen as central to depression. Accordingly, research on emotions in depression has proceeded with fury. The urgency of the work has tempted investigators to issue premature declarations and to sometimes overlook theoretical and methodological challenges entailed in studying emotion. I report on what we have learned thus far about how depression influences emotional reactivity and emotion regulation, and also carefully demarcate the vast terrain of what we do not yet know. Ironically, an attitude of humility may enable the field to achieve the ambitious but elusive goal of developing a rich, contextually specific account of depression-related changes in emotional reactivity and regulation. Such an account is a precondition for using knowledge about emotion to intervene more effectively to reduce depression\u27s worldwide burden

Psychological Flexibility as a Fundamental Aspect of Health

Traditionally, positive emotions and thoughts, strengths, and the satisfaction of basic psychological needs for belonging, competence, and autonomy have been seen as the cornerstones of psychological health. Without disputing their importance, these foci fail to capture many of the fluctuating, conflicting forces that are readily apparent when people navigate the environment and social world. In this paper, we review literature to offer evidence for the prominence of psychological flexibility in understanding psychological health. Thus far, the importance of psychological flexibility has been obscured by the isolation and disconnection of research conducted on this topic. Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values. In many forms of psychopathology, these flexibility processes are absent. In hopes of creating a more coherent understanding, we synthesize work in emotion regulation, mindfulness and acceptance, social and personality psychology, and neuropsychology. Basic research findings provide insight into the nature, correlates, and consequences of psychological flexibility and applied research provides details on promising interventions. Throughout, we emphasize dynamic approaches that might capture this fluid construct in the real-world

Emotion and Psychopathology: Bridging Affective and Clinical Science

This book explores a fundamental question that clinical researchers and practitioners alike must ask: When are emotions functional and when are they dysfunctional? Recent advances in affective science have provided for examining these age-old questions. The past few decades have witnessed an explosion of research on emotion accompanied by new theories. Emotion and Psychopathology: Bridging Affective and Clinical Science synthesizes theoretical and methodological developments in affective science and highlights their potential application to psychopathology. Contributors illustrate the importance of transferring basic research into the clinical area and consider the potential payoffs of using affective science to conceptualize and treat major mental disorders. They discuss schizophrenia, bipolar disorder, major depressive disorder, anxiety, and alcoholism as well as advances in emotion research methods, applications of affective methods to different forms of psychopathology, and future directions for existing interventions. This book will be of interest to all researchers and clinicians who wish to deepen their understanding of psychopathology

Maladaptive Mood Repair Responses Distinguish Young Adults with Early Onset Depressive Disorders and Predict Future Depressive Outcomes

Background: Clinical depression involves persistent dysphoria, implicating impaired affect regulation or mood repair failure. However, there is comparatively little information about the mood repair repertoires of individuals with histories of clinical depression, how their repertories differ from that of never-depressed people, and whether particular types of mood repair responses differentially contribute to depression risk. Method: Adult probands who had childhood-onset depressive disorder (n=215) and controls with no history of major mental disorder (n=122) reported which specific (cognitive, behavioral, interpersonal and somatic-sensory) responses they typically deploy when experiencing sad affect, including responses known to appropriately attenuate dysphoria (‘adaptive’ responses) and those known to exacerbate dysphoria in the short or long run (‘maladaptive’ responses). Subjects were longitudinally followed and evaluated. Results: Remitted probands and probands in depressive episodes both reported a greater number of maladaptive responses and fewer adaptive responses to their own sadness than did controls, although probands did not have an absolute deficiency of adaptive responses. Maladaptive (but not adaptive) mood repair responses predicted future increases in depression symptoms and an increased probability of a recurrent depressive episode among probands (even after controlling for several clinical predictors of course). Post-hoc analyses revealed that maladaptive non-cognitive and maladaptive cognitive mood repair response sets each predicted depression outcomes. Conclusions: Individuals with past and present episodes of depressive disorder report an array of cognitive and non-cognitive responses to their own sadness that are likely to exacerbate that affect, and this pattern predicts a worse course of the disorder

Non-response to Sad Mood Induction: Implications for Emotion Research

Experimental induction of sad mood states is a mainstay of laboratory research on affect and cognition, mood regulation, and mood disorders. Typically, the success of such mood manipulations is reported as a statistically significant pre- to post-induction change in the self-rated intensity of the target affect. The present commentary was motivated by an unexpected finding in one of our studies concerning the response rate to a well-validated sad mood induction. Using the customary statistical approach, we found a significant mean increase in self-rated sadness intensity with a moderate effect size, verifying the “success” of the mood induction. However, that “success” masked that, between one-fifth and about one-third of our samples (adolescents who had histories of childhood-onset major depressive disorder and healthy controls) reported absolutely no sadness in response to the mood induction procedure. We consider implications of our experience for emotion research by (1) commenting upon the typically overlooked phenomenon of nonresponse, (2) suggesting changes in reporting practices regarding mood induction success, and (3) outlining future directions to help scientists determine why some subjects do not respond to experimental mood induction

Why Might Poor Sleep Quality Lead to Depression? A Role for Emotion Regulation

Disordered sleep is strongly linked to future depression, but the reasons for this link are not well understood. This study tested one possibility – that poorer sleep impairs emotion regulation (ER), which over time leads to increased depressive symptoms. Our sample contained individuals with a wide range of depression symptoms (current depression, N = 54, remitted depression, N = 36, and healthy control, N = 53), who were followed clinically over six months and reassessed for changes in depressive symptom levels. As predicted, maladaptive ER mediated both cross-sectional and prospective relationships between poor sleep quality and depression symptoms. In contrast, an alternative mediator, physical activity levels, did not mediate the link between sleep quality and depression symptoms. Maladaptive ER may help explain why sleep difficulties contribute to depression symptoms; implications for interventions are discussed

Is the Divide a Chasm?: Bridging Affective Science with Clinical Practice

This special section endeavors to facilitate the integration of biologically-based assessments of emotion into the clinical setting. This goal is consistent with the Research Domain Criteria (RDoC) initiative, which aims to identify transdiagnostic biobehavioral mechanisms that underlie mental disorders. We focus on four challenges to applying biologically-informed research on emotion and emotion regulation to clinical contexts: (1) How do we assess emotion in an RDoC framework? (2) How do we integrate measures of emotion with other systems in a wider context? (3) What do physiological indices of emotion tell us about clinical phenomena? and (4) How do we integrate physiological assessments into clinical practice? Throughout this comment, we refer to the articles in this special section to make our points, and, when possible, offer suggestions for future work to continue to address these challenges