What happens when we get angry? Hormonal, cardiovascular and asymmetrical brain responses

Novel Assessment of the Impact of Irritability on Physiological and Psychological Frustration Responses in Adolescents

OBJECTIVE

Irritability, typically defined as a proneness to anger, particularly in response to frustration, falls at the intersection of emotion and disruptive behavior. Despite well-defined translational models, there are few convergent findings regarding the pathophysiology of irritability. Most studies utilize computer-based tasks to examine neural responses to frustration, with little work examining stress-related responding to frustration in social contexts. The present study is the first to utilize the novel Frustration Social Stressor for Adolescents (FSS-A) to examine associations between adolescent irritability and psychological and physiological responses to frustration.

METHOD

The FSS-A was completed by a predominantly male, racially, ethnically, and socioeconomically diverse sample of 64 12- to 17-year-olds, who were originally recruited as children with varying levels of irritability. Current irritability was assessed using the Multidimensional Assessment Profiles-Temper Loss scale (MAP-TL-Youth). Adolescents rated state anger and anxiety before and after the FSS-A, and usable salivary cortisol data were collected from 43 participants.

RESULTS

Higher MAP-TL-Youth scores were associated with greater increases in anger during the FSS-A, but not increases in anxiety, or alterations in cortisol. Pre-task state anger negatively predicted the slope of the rise in cortisol observed in anticipation of the FSS-A.

CONCLUSIONS

Results provide support for unique associations between adolescent irritability and anger during, and in anticipation of, frustrating social interactions. Such findings lay a foundation for future work aimed at informing physiological models and intervention targets.

Salivary cortisol awakening levels are reduced in human subjects with intermittent explosive disorder compared with controls

BACKGROUND

The role of the hypothalamic-pituitary-adrenal (HPA) axis in human aggressive behavior is poorly characterized, though some studies report that, unlike depression, circulating or salivary levels of cortisol are low compared with controls.

METHODS

In this study, we collected three salivary cortisol levels (two in the morning and one in the evening) on three separate days in 78 adult study participants with (n = 28) and without (n = 52) prominent histories of impulsive aggressive behavior. Plasma C-Reactive Protein (CRP) and Interleukin-6 (IL-6) were also collected in most study participants. Aggressive study participants meet DSM-5 criteria for Intermittent Explosive Disorder (IED) while non-aggressive participants either had a history of a psychiatric disorder or no such history (Controls).

RESULTS

Morning, but not evening, salivary cortisol levels were significantly lower in IED (p < 0.05), compared with control, study participants. In addition, salivary cortisol levels correlated with measures of trait anger (partial r = -0.26, p < 0.05) and aggression (partial r = -0.25, p < 0.05) but not with measures of impulsivity, psychopathy, depression, history of childhood maltreatment, or other tested variables that often differ in individuals with IED. Finally, plasma CRP levels correlated inversely with morning salivary cortisol levels (partial r = -0.28, p < 0.05); plasma IL-6 levels showed a similar, though not statistically significant (rp = -0.20, p = 0.12) relationship with morning salivary cortisol levels.

CONCLUSION

The cortisol awakening response appears to be lower in individuals with IED compared with controls. In all study participants, morning salivary cortisol levels correlated inversely with trait anger, trait aggression, and plasma CRP, a marker of systemic inflammation. This suggests the present of a complex interaction between chronic-low level inflammation, the HPA axis, and IED that warrants further investigation.

The Effects of Heart Rate Variability (HRV) Biofeedback on HRV Reactivity and Recovery During and After Anger Recall Task for Patients with Coronary Artery Disease

Patients with coronary artery disease (CAD) often experience anger events before cardiovascular events. Anger is a psychological risk factor and causes underlying psychophysiological mechanisms to lose balance of the autonomic nervous system (ANS). The heart rate variability (HRV) was the common index for ANS regulation. It has been confirmed that heart rate variability biofeedback (HRV-BF) restored ANS balance in patients with CAD during the resting state. However, the effects of HRV-BF during and after the anger event remain unknown. This study aimed to examine the effects of HRV-BF on ANS reactivity and recovery during the anger recall task in patients with CAD. This study was a randomized control trial with a wait-list control group design, with forty patients in the HRV-BF group (for six sessions) and 44 patients in the control group. All patients received five stages of an anger recall task, including baseline, neutral recall task, neutral recovery, anger recall task, and anger recovery. HRV reactivity in the HRV-BF group at the post-test was lower than that in the control group. HRV recovery at the post-test in the HRV-BF group was higher than that in the control group. The HRV-BF reduced ANS reactivity during anger events and increased ANS recovery after anger events for CAD patients. The possible mechanisms of HRV-BF may increase total HRV, ANS regulation, and baroreflex activation at anger events for patients with CAD, and may be a suitable program for cardiac rehabilitation.

Machismo and Caballerismo Linked with Perceived Social Discrimination and Powerlessness in U.S. Latino Men

Concepts from the Threat Appraisal and Coping Theory, Precarious Manhood Theory, and Ambivalent Sexism suggest that U.S. Latino men who perceive social discrimination and powerlessness may respond with machismo beliefs that serve as coping responses to empower themselves and reassert their manhood. Machismo beliefs include both aggressive “traditional machismo” and gentlemanly family-focused “caballerismo.” Because past research has revealed that individuals respond to social abuse with anger, prompting them to feel empowered but less empathetic, we hypothesized that Latino men who perceive social discrimination combined with a sense of powerlessness would report more traditional machismo and less caballerismo. We also hypothesized that this three-variable sequence would be stronger for men with high rather than low in Latino identity, since discrimination would be a more personal threat to their identity and manhood. Participants included 1,530 U.S. Latinos who completed online surveys to report demographics (age, education, employment, sexual orientation, partner status, household size), perceived social discrimination, powerlessness, traditional machismo, caballerismo, and Latino identity. Mediational analyses confirmed the three-variable sequence in which powerlessness mediated associations between social discrimination and (more) aggressive machismo, and (less) gentlemanly caballerismo. Also as hypothesized, moderated mediational analysis revealed that these three-variable sequences were stronger for men with high rather than low Latino identity. With recent increases in social discrimination against U.S. Latinos, present results caution that men may respond to these challenges with increased aggressive patterns of traditional machismo.

Prescriptive analytics for impulsive behaviour prevention using real-time biometrics

The present biometric market segment has been captured by compact, lightweight sensors which are capable of reading the biometric fluctuations of a user in real-time. This biometric market segment has further facilitated rise of a new ecosystem of wearable devices helpful in tracking the real-time physiological data for Healthcare-related analysis. However, the devices in the smart-wearable ecosystem are limited to capturing and displaying the biometrics without any prescriptive analytics. This paper addresses this gap to analyse the human emotion space based on an individual’s state of mind over the past 60 min and employs Deep Learning and Bayesian prediction techniques to predict the possibility of an impulsive outburst within upcoming few minutes. A lightweight smart processing device mounted with sensors captures the biometrics of the user and calibrate the same to the mental state of the user on a scale of zero to hundred. The results reveal that the deep learning algorithm along with the Bayesian probability module can predict the future mood fluctuations of the user with lower error than the other contemporary models. The predicted mood fluctuations has matched with the actual mood changes of the experimental subject within \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \pm 10 $$\end{document}±10 min of the predicted time index in 93% of the cases and within \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \pm 5 $$\end{document}±5 min in 82% of the cases.

Vagal signaling and the somatic marker hypothesis: The effect of transcutaneous vagal nerve stimulation on delay discounting is modulated by positive mood

Controlling impulsivity and delaying gratifications are key features of effective self-control. Delay Discounting (DD) indexes the ability to delay rewards and previous research has shown that discounting is influenced by affective states such as mood. According to the Somatic Marker Hypothesis (SMH), afferent somatic signals, such as mood, are carried by the vagus and can influence decision making. In the current study, we employed transcutaneous vagus nerve stimulation (tVNS), a novel non-invasive brain stimulation technique that stimulates the auricular branch of the afferent vagus nerve (located in the outer ear), to assess its effects on decision impulsivity, while taking into account individuals' mood and resting-state HRV as a possible confounding factor. Employing a within-subjects cross-over design, 94 participants received active or sham tVNS while performing delay discounting in two separate sessions. As compared to sham, active tVNS increased discounting, but only for individuals reporting lower positive mood, regardless of the level of negative mood reported. We evidence that the effect of tVNS on reward discounting depends on the level of positive mood. This result suggests that positive mood state might be a proxy of task-relevant arousal, likely influencing the effectiveness of afferent vagal stimulation on self-control processes, as temporal discounting.

Psychobiological response to an anger induction task in schizophrenia: The key role of anxiety

In this study an anger induction laboratory task was applied to men with schizophrenia, and resulted in significant changes in different psychophysiological parameters that were measured in a pre-post design. We observed a significantly greater self-reported anger mood and negative affection, lower self-reported positive affection, an increase in cardiovascular reactivity (with blood pressure in deeper affection compared to controls), higher salivary testosterone levels, lower salivary cortisol levels, and an increase in right ear items reported in dichotic listening. Furthermore, clinical risk factors related to anger in our patients were analyzed by Stepwise Regression analyses. Trait anger was significantly associated with a higher level of delusional pathology and impulsivity. Regarding the resulted state of anger as an output of the induction, the most relevant finding was that anxiety consistently and significantly predicted the increasing in anger feelings, and, remarkably, it predicted also the increasing in T levels and the cardiovascular reactivity of the patients.

Exploring the pathophysiology of emotion-based impulsivity: The roles of the sympathetic nervous system and hostile reactivity

The tendency to engage in impulsive behavior in the context of negative affect, known as negative urgency, has emerged as a powerful transdiagnostic predictor of behavioral dysregulation. Although general vulnerability to negative affect (neuroticism) correlates with negative urgency, not all neurotic individuals engage in urgent behavior. Given prior experimental evidence that sympathetic nervous system (SNS) activation may promote emotion-related impulsivity, the present study examines tonic SNS activity as a moderator of the link between neuroticism and negative urgency. Participants (N = 194) completed measures of neuroticism and negative urgency, as well as a stress task. They also underwent assessment of tonic SNS activity (cardiac pre-ejection period). The link between neuroticism and negative urgency was strengthened for individuals with higher tonic SNS activity; however, this was not the case for behavioral performance on the task. A similar pattern was demonstrated for hostile reactivity to the stress task; increased hostile response partially explained the interaction between SNS activation and neuroticism on negative urgency. These findings suggest a potential facilitative role of the SNS in hostile reactivity and emotion-driven impulsivity among more neurotic individuals.

The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care: A Review of the Literature

The burden of alcohol and drug use disorders (substance use disorders [SUDs]) has intensified efforts to expand access to cost-effective psychosocial interventions and pharmacotherapies. This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs.

Eliciting Negative Affects Using Film Clips and Real-Life Methods

Although audio-visual stimuli are among the most frequently used methods to elicit emotional reactions in experimental conditions, real-life manipulations have increasingly been used in different countries. However, the applicability of such protocols has not yet been tested in Brazilian Portuguese speakers. Thus, we conducted two experiments to investigate the effectiveness of both methods. In the first experiment, we used film clips to induce negative emotions (i.e., anger, fear, or sadness) or an emotionally neutral condition in 321 undergraduate students. After watching one of the online videos, volunteers completed an emotional assessment. As expected, there were significant differences in all groups. Our results corroborate the relatively discrete patterns in emotion elicitation using films. In the second experiment, anger was elicited in 18 male undergraduates through a hostile social interaction with a confederate and measured by the corrugator muscle activity and cortisol responses. Indeed, there was an increase in corrugator activity in the group exposed to anger induction, even after a few minutes from the end of the experimental manipulation. Implications for experiments on the negative emotions are discussed.

Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal

Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.

Individual Differences in Automatic Emotion Regulation Interact with Primed Emotion Regulation during an Anger Provocation

The current study investigated the interactive effects of individual differences in automatic emotion regulation (AER) and primed emotion regulation strategy on skin conductance level (SCL) and heart rate during provoked anger. The study was a 2 × 2 [AER tendency (expression vs. control) × priming (expression vs. control)] between subject design. Participants were assigned to two groups according to their performance on an emotion regulation-IAT (differentiating automatic emotion control tendency and automatic emotion expression tendency). Then participants of the two groups were randomly assigned to two emotion regulation priming conditions (emotion control priming or emotion expression priming). Anger was provoked by blaming participants for slow performance during a subsequent backward subtraction task. In anger provocation, SCL of individuals with automatic emotion control tendencies in the control priming condition was lower than of those with automatic emotion control tendencies in the expression priming condition. However, SCL of individuals with automatic emotion expression tendencies did no differ in the automatic emotion control priming or the automatic emotion expression priming condition. Heart rate during anger provocation was higher in individuals with automatic emotion expression tendencies than in individuals with automatic emotion control tendencies regardless of priming condition. This pattern indicates an interactive effect of individual differences in AER and emotion regulation priming on SCL, which is an index of emotional arousal. Heart rate was only sensitive to the individual differences in AER, and did not reflect this interaction. This finding has implications for clinical studies of the use of emotion regulation strategy training suggesting that different practices are optimal for individuals who differ in AER tendencies.

Correlations between impulsiveness and biochemical parameters in women with polycystic ovary syndrome

OBJECTIVE

The aim of this study was to investigate the relationship between anger, impulsiveness, and biochemical parameters (testosterone, insulin, insulin resistance) in women with polycystic ovary syndrome.

STUDY DESIGN

We recruited 84 women diagnosed with polycystic ovary syndrome according to the Rotterdam diagnostic criteria. Psychiatric interviews were performed using the Structured Clinical Interview for DSM-IV Axis I Disorders. The Barratt Impulsiveness Scale and the State Trait Anger Expression Inventory were also administered to each participant. Lastly, the women's biochemical parameters, which included total testosterone, free androgen index, dehydroepiandrosterone sulfate, insulin and insulin resistance, thyroid functions, and prolactin, were measured.

RESULTS

A statistically significant correlation was found between participants' increasing total testosterone levels and total impulsiveness scores, and their increasing free androgen index levels and motor and non-planning-related impulsiveness (r=0.24, p=0.027; r=0.27, p=0.015; and r=0.26, p=0.017, respectively). High insulin and insulin resistance levels were associated with high non-planning-related impulsiveness scores (r=0.26, p=0.018; and r=0.26, p=0.019). Lastly, high trait anger and anger expression scores were related to high total testosterone and insulin and insulin resistance levels.

CONCLUSION

Androgens and glucose dysregulation seemingly affect anger expression as well as the attentional, motor, and non-planning-related impulsiveness of women with polycystic ovary syndrome.

The Use of Testosterone/Cortisol Ratio in Response to Acute Stress as an Indicator of Propensity to Anger in Informal Caregivers

Caring for an offspring diagnosed with a psychological chronic disorder is used in research as a model of chronic stress. Indeed, it is usually associated with disturbances in the salivary cortisol (Csal) levels of the caregiver. An imbalance between salivary testosterone (Tsal) and Csal levels is a marker of proneness to social aggression. Given this, we aimed to establish whether the salivary testosterone/cortisol (Tsal/Csal) ratio response to acute stress could be employed as a marker of proneness to anger in informal caregivers of offspring with autism spectrum (ASD). Tsal/Csal ratio and anger responses to a set of different cognitive tasks as well as anger trait and expression were compared in these informal caregivers and controls. Caregivers, particularly those of offspring with ASD, had higher Tsal/Csal ratios than controls in response to acute stress, concretely after the stress in the case of fathers (p = .05) and before stress when analyzing mothers (p = .05). Moreover, ASD fathers and mothers obtained higher magnitude of the T/C ratio response to stress (p = .03 and p =.04, respectively), anger state (p = .02 and p = .02, respectively) and expression scores (p = .05 and p = .05, respectively) than controls. Finally, high Tsal/Csal ratio levels and response to stress were significantly associated with high anger feelings increases (p .05, respectively) and expression (p .05, respectively) in caregivers.

Cerebral lateralization of pro- and anti-social tendencies

Mounting evidence suggest that the right-hemisphere (RH) has a relative advantage, over the left-hemisphere (LH), in mediating social intelligence - identifying social stimuli, understanding the intentions of other people, awareness of the dynamics in social relationships, and successful handling of social interactions. Furthermore, a review and synthesis of the literature suggest that pro-social attitudes and behaviors are associated with physiological activity in the RH, whereas unsocial and anti-social tendencies are mediated primarily by the LH. This hemispheric asymmetry is rooted in several neurobiological and functional differences between the two hemispheres. (I) Positive social interactions often require inhibiting one's immediate desires and considering the perspectives and needs of others. Given that self-control is mediated by the RH, pro-social emotions and behaviors are, therefore, inherently associated with the RH as it subserves the brain's self-restraint mechanisms. (II) The RH mediates experiences of vulnerability. It registers the relative clumsiness and motor weakness of the left limbs, and it is involved, more than the LH, in processing threats and mediating fear. Emotional states of vulnerability trigger the need for affiliation and sociality, therefore the RH has a greater role in mediating pro-social attitudes and behaviors. (III) The RH mediates a holistic mode of representing the world. Holistic perception emphasizes similarities rather than differences, takes a long-term perspective, is associated with divergent thinking and seeing other points-of-view, and it mediates a personal mode of relating to people. All these features of holistic perception facilitate a more empathetic attitude toward others and pro-social behaviors.

High testosterone levels and sensitivity to acute stress in perpetrators of domestic violence with low cognitive flexibility and impairments in their emotional decoding process: a preliminary study

Hormonal and neuropsychological impairment in intimate partner violence (IPV) perpetrators could play a role in domestic violence. For characterizing whether there is a specific psychobiological response to stress, participants who had previously been jailed for IPV and controls were compared for testosterone and cortisol levels, tested for 2D:4D ratio (as an indicator of masculinization), and given several trait questionnaires and neuropsychological tests related to executive functions and theory of mind. After performing the Trier Social Stress Test (TSST), IPV perpetrators experienced decreases in salivary testosterone (T) levels, a moderate worsening of mood, slight anxiety, and a salivary cortisol (C) level increase. Moreover, high basal T was related with high levels of anger and anxiety and worse mood. However, that basal mood does not significantly alter T levels in response to stress. Nonetheless, controls experienced smaller changes in T and larger changes in C and psychological mood. With respect to neuropsychological and cognitive empathic features, IPV perpetrators showed poorer executive performance and emotional recognition than controls. In addition, deficits in both neuropsychological domains were positively associated. Regarding emotional empathy, IPV perpetrators showed higher levels of personal distress than controls. The 2D:4D ratio was lower in IPV perpetrators than in controls. Moreover, only in the former a smaller 2D:4D ratio was related to large increases in T in response to stress and poor emotional recognition. Together with social aspects involved in IPV, differences in psychobiological variables and their relationships could play a relevant role in the onset and perpetuation of violent behavior.

Testosterone/cortisol ratio in response to acute stress: a possible marker of risk for marital violence

Testosterone to cortisol (T/C) ratios could be associated with feelings and expression of anger as high testosterone and low cortisol levels indicate a predisposition to violence. The basal T/C ratio has recently been proposed as a marker for proneness to social aggression; so far, however, only its value as an indicator of state anger or violence has been investigated. Given this, we aimed to establish whether the T/C ratio response to acute stress was a specific psychobiological feature in individuals with a history of violence, namely, perpetrators of intimate partner violence (IPV). T/C ratio and anger responses were compared in men jailed for IPV and controls using the Trier Social Stress Test. IPV perpetrators had higher T/C ratios than controls, during the preparation period, and 15 and 30 minutes post-task. In IPV perpetrators, high T/C ratios were linked to better self-esteem and good mental health. An increase in anger may increase proneness to violence by altering hormones and, thereby, increasing T/C ratios. The basal T/C ratio together with acute stress responses and other indicators could serve as a marker to identify men at high risk of reacting violently to their partners.

Sources of somatization: exploring the roles of insecurity in relationships and styles of anger experience and expression

Research in the U.S. has shown strong connections between insecure attachment in close relationships and somatization. In addition, studies have demonstrated connections between somatic symptoms and anger experience and expression. In this study, we integrate perspectives from these two literatures by testing the hypothesis that proneness to anger and suppression of anger mediate the link between insecurity in relationships and somatization. Between 2000 and 2003, a community-based sample of 101 couples in a large U.S. city completed self-report measures, including the Somatic Symptom Inventory, the Relationship Scales Questionnaire, the Multidimensional Anger Inventory, the Revised Conflict Tactics Scale, and the Beck Depression Inventory. Controlling for age, income, and recent intimate partner violence, analyses showed that the link between insecure attachment and somatization was partially mediated by anger proneness for men and by anger suppression for women. Findings are consistent with the hypothesis that men who are insecurely attached are more prone to experience anger that in turn fosters somatization. For women, findings suggest that insecure attachment may influence adult levels of somatization by fostering suppression of anger expression. Specific clinical interventions that help patients manage and express angry feelings more adaptively may reduce insecurely attached individuals' vulnerability to medically unexplained somatic symptoms.

Androgen levels and anger and impulsivity measures as predictors of physical, verbal and indirect aggression in boys and girls

Previous studies indicate that androgen levels and certain psychological characteristics such as anger and impulsivity are related to the development and maintenance of aggression. Further studies are required to analyze the potential predictor role of the interaction of said factors on aggressive behavior. 90 nine-year-old children (44 boys and 46 girls) were assessed in relation to their levels of physical, verbal and indirect aggression, using a peer-rating technique. Testosterone and androstenedione levels were analyzed using an enzymoimmunoassay technique in saliva samples. Anger (state and trait) and anger control were measured using the STAXI-NA, and impulsivity was measured through the MFF-20. A General Linear Model revealed that sex was the best predictor for aggression measures, with boys scoring higher than girls in physical, verbal and indirect aggression; after sex, testosterone was found to be the best predictor (in a positive sense) of all three types of aggressive behavior studied. In addition to observing a main effect of androstenedione on physical and verbal aggression, a 'state anger*androstenedione' interaction was found to predict these types of aggression, with androstenedione acting as a moderator (inhibitor) of the effects of anger on these behaviors; also, a 'state anger*testosterone' interaction was found to predict verbal aggression. The results support the idea that, after sex, androgens constitute a biological marker to be taken into consideration in relation to individual differences in aggressive behavior. It is possible that at the age of 9, testosterone tends to increase aggression, while androstenedione tends to moderate (inhibit) the effects of anger on aggression.

The sad, the angry, and the asymmetrical brain: dichotic listening studies of negative affect and depression

Dichotic Listening (DL) is a valuable tool to study emotional brain lateralization. Regarding the perception of sadness and anger through affective prosody, the main finding has been a left ear advantage (LEA) for the sad but contradictory data for the anger prosody. Regarding an induced mood in the laboratory, its consequences upon DL were a diminished right ear advantage (REA) for the induction of sadness and an increased REA for the induction of anger. The global results fit with the approach-withdrawal motivational model of emotional processing, pointing to sadness as a right hemisphere emotion but anger processed bilaterally or even in the left hemisphere, depending on the subject's preferred mode of expression. On the other hand, the study of DL in clinically depressed patients found an abnormally larger REA in verbal DL tasks which was predictive of therapeutic pharmacological response. However, the mobilization of the available left hemisphere resources in these responders (reflected in a higher REA) would indicate a remission of the episode but would not assure the absence of new relapses.