"Sensitivity" of depressed individuals to aversive stimuli

Sleep-wake variations of electrodermal activity in bipolar disorder

BACKGROUND

Affective states influence the sympathetic nervous system, inducing variations in electrodermal activity (EDA), however, EDA association with bipolar disorder (BD) remains uncertain in real-world settings due to confounders like physical activity and temperature. We analysed EDA separately during sleep and wakefulness due to varying confounders and potential differences in mood state discrimination capacities.

METHODS

We monitored EDA from 102 participants with BD including 35 manic, 29 depressive, 38 euthymic patients, and 38 healthy controls (HC), for 48 h. Fifteen EDA features were inferred by mixed-effect models for repeated measures considering sleep state, group and covariates.

RESULTS

Thirteen EDA feature models were significantly influenced by sleep state, notably including phasic peaks (p < 0.001). During wakefulness, phasic peaks showed different values for mania (M [SD] = 6.49 [5.74, 7.23]), euthymia (5.89 [4.83, 6.94]), HC (3.04 [1.65, 4.42]), and depression (3.00 [2.07, 3.92]). Four phasic features during wakefulness better discriminated between HC and mania or euthymia, and between depression and euthymia or mania, compared to sleep. Mixed symptoms, average skin temperature, and anticholinergic medication affected the models, while sex and age did not.

CONCLUSION

EDA measured from awake recordings better distinguished between BD states than sleep recordings, when controlled by confounders.

La clinique polydimensionnelle de l’humeur dépressive. Nouvelle version de l’échelle EHD

Dans le domaine de la recherche en psychiatrie, un nouvel intérêt paraît se dessiner pour les émotions. Notre travail s’inscrit dans ce courant et relate les résultats obtenus avec une échelle polydimensionnelle d'évaluation de l’humeur dépressive. Une analyse en composantes principales (ACP) a été pratiquée sur la matrice de corrélations des 18 items de l'échelle administrée à 70 patients hospitalisés présentant un épisode dépressif majeur. Cinq facteurs se dégagent, ayant un sens clinique et statistique avant comme après rotation Vanmax: émoussement affectif, tristesse hyperexpressive/incontinence émotionnelle, irritabilité, labilité affective et tristesse douloureuse (Tableau II). Cet éclatement, en plusieurs dimensions, de l’humeur dépressive confirme qu’il s’agit bien d’un concept polysémique et non d’une entité clinique univoque. Les cinq composantes issues de l’ACP ne correspondent pas à des niveaux de complexité équivalente Certaines, comme la labilité affective, sont relativement simples alors que d’autres proviennent d’un arrangement complexe entre des symptômes correspondant à des niveaux d’observation très variés. Ceci plaide en faveur d’un dénombrement horizontal (selon les émotions identifiées) et vertical (selon les niveaux expressifs) de la sémiologie des affects chez les déprimés. Nous faisons l'hypothèse que de nombreux symptômes correspondent à des objets chimériques issus d’une réorganisation pathologique des niveaux expressits.

Psychometric Properties of Scales for the Measurement of Psychosocial Variables Associated with Depression in Adolescence1

In preparation for a community-based study of depression in adolescence, several pilot studies were conducted with samples of adolescents. The purpose of these studies was to evaluate the reliability and association with depression of several instruments when used with older (14- to 18-year-old) adolescents. These instruments included measures of cognitions, body image, self-esteem, self-awareness, social interactions with peers and family, social support, micro- and macrostressful life events, anxiety and tension, positive affect, antisocial or oppositional behavior, suicidal ideation, and vocabulary. The internal consistency reliability and stability of most of the instruments were satisfactory. In addition, most instruments were associated with a measure of depression, Radloff's Center for Epidemiological Studies-Depression Scale. Several of the scales were successfully abbreviated using techniques based on factor analysis and item analysis.

Appetitive and aversive motivation in depression: The temporal dynamics of task-elicited asymmetries in alpha oscillations

The capability model of alpha asymmetries posits that state emotional manipulations are a more powerful detector of depression-related motivational deficits than alpha activity at rest. The present study used a time-frequency approach to investigate the temporal dynamics of event-related changes in alpha power during passive viewing of emotional pictures in individuals with dysphoria (n = 23) and in individuals without dysphoria (n = 24). In the whole group, the processing of pleasant and unpleasant compared to neutral pictures was associated with a decrease in event-related alpha power (i.e., alpha desynchronization) at centro-parietal and parietal scalp sites in the 538–1400 ms post-stimulus. The group with dysphoria revealed a smaller alpha desynchronization than the group without dysphoria in response to pleasant, but not neutral and unpleasant, stimuli at frontal, fronto-central and centro-parietal sites. Interestingly, at central and centro-parietal scalp sites, the difference between groups in response to pleasant stimuli was lateralized to the right hemisphere, whereas no clear lateralization was observed at frontal and fronto-central scalp sites. These findings suggest that decreased cortical activity (i.e., reduced alpha desynchronization) in a network involving bilateral frontal and right-lateralized parietal regions may provide a specific measure of deficits in approach-related motivation in depression.

The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis

BACKGROUND

Electrodermal activity (EDA) and other peripheral autonomic electrical parameters have been used as indicators of emotional states, including depressive states and suicidal state. We aimed to review EDA research systematically, focusing on EDA's usefulness as a biomarker for depression and suicidal behaviour.

METHODS

We searched MEDLINE, Scopus, Cochrane Library, and Web of Science databases, following PRISMA guidelines. The initial screening of articles was based on titles and abstracts; then the full text was reviewed. A preliminary synthesis of findings was developed using tables, thematic analysis and quality ratings.

RESULTS

1287 articles were screened and 77 relevant studies were identified and included in the systematic review. The studies were fairly consistent in maintaining that hypoactive electrodermal response is an established feature of patients affected by depression. There is also preliminary evidence that monitoring EDA may help to differentiate the phases of mood disorders. A few studies provided evidence that EDA can be used to differentiate acutely suicidal subjects from depressed patients who are not severely suicidal. Although EDA has been shown to be a valid, sensitive marker of suicidal ideation, suicide attempts and violent suicidal behaviour, it also seems to be influenced to some extent by antidepressant treatment.

CONCLUSIONS

Most of the studies summarised in this review are quite outdated and employed a variety of designs and methods to evaluate EDA. This limits the generalisability of the results and makes it difficult to draw clear conclusions about the role of EDA in real-world settings. Electrodermal hypoactivity seems to be a reliable feature of depression and a valid marker of suicidal risk. Nevertheless, the potential utility of EDA in diagnosis, prevention, and treatment planning for depression and suicidal behaviour, should be thoroughly studied.

Use of Behavioral Therapy and Imipramine

A case of obsessive-compulsive neurosis with severe depression was treated by the combined use of (1) exposure and response prevention and (2) imipramine. While compulsive rituals disappeared after three weeks of behavioral treatment, obsessions and depression diminished only after the introduction of imipramine. The patient remained asymptomatic at a follow-up of six months. The relationship between depression and obsessive-compulsive symptoms, as well as the optimal order in which behavioral and pharmacological interventions are introduced, is discussed.

Depression is associated with increased vagal withdrawal during unpleasant emotional imagery after cardiac surgery

BACKGROUND

The aim of this study was to examine the influence of depression on heart rate and heart rate variability (HRV) during emotional imagery in patients after cardiac surgery.

METHODS

Based on the scores of the Center for Epidemiological Studies of Depression (CES-D) scale, 28 patients after cardiac surgery were assigned either to the group with depression (CES-D scores ≥ 16; N = 14) or the one without depression (CES-D scores<16; N = 14). Each patient completed a rest period and an emotional imagery including pleasant, neutral and unpleasant scripts. Inter-beat intervals (IBIs) and HRV were measured during the entire protocol.

RESULTS

Compared to nondepressed patients, those with depression had greater reductions in high frequency expressed in normalized units (HF n.u.) during the imaging of the unpleasant script (p = .003, Cohen's d = 1.34). Moreover, HF n.u. were lower during the imaging of the unpleasant script than the pleasant one in depressed patients only (p = .020, Cohen's d = 0.55). CES-D scores were also inversely correlated with residualized changes in IBIs (r = -.38, p = .045) and HF n.u. (r = -.49, p = .008) from rest to the imaging of the unpleasant script.

CONCLUSIONS

The relationship between depression and increased vagal withdrawal during unpleasant emotional imagery extends to patients after cardiac surgery. The present study suggests that increased vagal withdrawal to negative emotions in patients after cardiac surgery may mediate the conferral of cardiac risk by depression.

Mothers’ Depressive Symptoms Predict Both Increased and Reduced Negative Reactivity

This study examined whether, as mothers’ depressive symptoms increase, their expressions of negative emotion to children increasingly reflect aversion sensitivity and motivation to minimize ongoing stress or discomfort. In multiple interactions over 2 years, negative affect expressed by 319 mothers and their children was observed across variations in mothers’ depressive symptoms, the aversiveness of children’s immediate behavior, and observed differences in children’s general negative reactivity. As expected, depressive symptoms predicted reduced maternal negative reactivity when child behavior was low in aversiveness, particularly with children who were high in negative reactivity. Depressive symptoms predicted high negative reactivity and steep increases in negative reactivity as the aversiveness of child behavior increased, particularly when high and continued aversiveness from the child was expected (i.e., children were high in negative reactivity). The findings are consistent with the proposal that deficits in parenting competence as depressive symptoms increase reflect aversion sensitivity and motivation to avoid conflict and suppress children’s aversive behavior.

Mood symptoms and emotional responsiveness to threat in school-aged children

Clinical accounts of depression underscore its relation to negative emotional experiences; yet few empirical studies examine emotional experiences in adults with depression, with even less work on depression and emotion in children. Using a nonclinical sample of school-aged children (n = 89) ages 8 to 12, this study evaluated whether greater mood symptoms were associated with more or less intense emotional reactions (measured via psychophysiology, subjective report, and behavior) in response to a threat paradigm. Results indicated that greater negative mood symptoms were associated with larger startle magnitude responses during threat, increased self-reports of negative emotion, and greater likelihood of crying and stopping the paradigm prematurely.

Impact of personality on the cerebral processing of emotional prosody

While several studies have focused on identifying common brain mechanisms governing the decoding of emotional speech melody, interindividual variations in the cerebral processing of prosodic information, in comparison, have received only little attention to date: Albeit, for instance, differences in personality among individuals have been shown to modulate emotional brain responses, personality influences on the neural basis of prosody decoding have not been investigated systematically yet. Thus, the present study aimed at delineating relationships between interindividual differences in personality and hemodynamic responses evoked by emotional speech melody. To determine personality-dependent modulations of brain reactivity, fMRI activation patterns during the processing of emotional speech cues were acquired from 24 healthy volunteers and subsequently correlated with individual trait measures of extraversion and neuroticism obtained for each participant. Whereas correlation analysis did not indicate any link between brain activation and extraversion, strong positive correlations between measures of neuroticism and hemodynamic responses of the right amygdala, the left postcentral gyrus as well as medial frontal structures including the right anterior cingulate cortex emerged, suggesting that brain mechanisms mediating the decoding of emotional speech melody may vary depending on differences in neuroticism among individuals. Observed trait-specific modulations are discussed in the light of processing biases as well as differences in emotion control or task strategies which may be associated with the personality trait of neuroticism.

Emotion Context Insensitivity in Major Depressive Disorder

The present study tested 3 competing views of how depression alters emotional reactivity: positive attenuation (reduced positive), negative potentiation (increased negative), and emotion context insensitivity (ECI; reduced positive and negative). Normative and idiographic stimuli that elicited happy, sad, and neutral states were presented to currently depressed, formerly depressed, and healthy control individuals while experiential, behavioral, and autonomic responses were measured. Currently depressed individuals reported less sadness reactivity and less happiness experience across all conditions than did the other participants, and they exhibited a more dysphoric response to idiographic than to normative stimuli. Overall, data provide partial support for the positive attenuation and ECI views. Depression may produce mood-state-dependent changes in emotional reactivity that are most pronounced in emotion experience reports.

Attentional biases for negative interpersonal stimuli in clinical depression

An information-processing paradigm was used to examine attentional biases in clinically depressed participants, participants with generalized anxiety disorder (GAD), and nonpsychiatric control participants for faces expressing sadness, anger, and happiness. Faces were presented for 1000 ms, at which point depressed participants had directed their attention selectively to depression-relevant (i.e., sad) faces. This attentional bias was specific to the emotion of sadness; the depressed participants did not exhibit attentional biases to the angry or happy faces. This bias was also specific to depression; at 1000 ms, participants with GAD were not attending selectively to sad, happy, or anxiety-relevant (i.e., angry) faces. Implications of these findings for both the cognitive and the interpersonal functioning of depressed individuals are discussed and directions for future research are advanced.

The Social Risk Hypothesis of Depressed Mood: Evolutionary, Psychosocial, and Neurobiological Perspectives

The authors hypothesize that depressed states evolved to minimize risk in social interactions in which individuals perceive that the ratio of their social value to others, and their social burden on others, is at a critically low level. When this ratio reaches a point where social value and social burden are approaching equivalence, the individual is in danger of exclusion from social contexts that, over the course of evolution, have been critical to fitness. Many features of depressed states can be understood in relation to mechanisms that reduce social risk in such circumstances, including (a) hyper-sensitivity to signals of social threat from others, (b) sending signals to others that reduce social risks, and (c) inhibiting risk-seeking (e.g., confident, acquisitive) behaviors. These features are discussed in terms of psychosocial and neurobiological research on depressive phenomena.

Sadness and amusement reactivity differentially predict concurrent and prospective functioning in major depressive disorder

Depressed individuals often fail to react to emotionally significant stimuli. The significance of this pattern of emotional dysregulation in depression is poorly understood. In the present study, depressed and nondepressed participants viewed standardized neutral, sad, fear, and amusing films; and experiential, behavioral, and physiological responses to each film were assessed. Compared with nondepressed controls, depressed participants reported sadness and amusement in a flattened, context-insensitive manner. Those depressed participants who reported the least reactivity to the sad film exhibited the greatest concurrent impairment. Prospectively, the depressed participant who exhibited the least behavioral and heart rate reactivity to the amusing film were the least likely to recover from depression. Loss of the context-appropriate modulation of emotion in depression may reflect a core feature of emotion dysregulation in this disorder.

Regulation of negative affect during mother-child problem-solving interactions: adolescent depressive status and family processes

Despite recent suggestions that depression can be conceptualized as a disorder of affect regulation, relatively little research has focused on affect regulation skills in depressed individuals. This paper investigated whether depressed adolescents (N = 25) differ from nondepressed adolescents (N = 25) on two indices of affect regulation (i.e., duration of negative affective states and reciprocity of maternal negative affect) as well as whether these indices are related to microsocial family interactional processes. Analyses revealed that depressed teens differed from their nondepressed peers with regard to duration of negative affective states but not in their likelihood of reciprocating negative affect. Additionally, indices of adolescent affect regulation were related to family interactional processes. Duration of depressive affect was positively associated with maternal display of facilitative behavior contingent on adolescent depressive behavior. Duration of aggressive behavior was inversely related to maternal problem-solving responses to aggressive behavior. Finally, adolescent reciprocity of maternal depressive and aggressive behaviors was strongly associated with mothers' reciprocity of adolescents' negative affective behavior.

Affective startle modulation in clinical depression: preliminary findings

BACKGROUND

Modulation of the startle reflex by affective foreground stimuli was investigated in a group receiving inpatient treatment for major depressive episodes (n = 14) and an age and gender matched nondepressed group (n = 14).

METHODS

Participants viewed 27 pleasant, neutral, and unpleasant pictures chosen from the International Affective Picture System. Acoustic startle probes were presented during picture viewing, and participants also rated the affective qualities of the pictures.

RESULTS

While ratings of the pictures were largely similar between the depressed and nondepressed groups, they displayed dissimilar patterns of startle modulation. In the nondepressed group, blinks elicited during unpleasant pictures were significantly larger than during pleasant pictures, whereas the depressed group failed to show this effect. Analyses, which separated the depressed participants into moderate and severe groups based on Beck Depression Inventory scores, revealed that while the moderately depressed group also showed a normal pattern of startle modulation, the severely depressed showed potentiated startles during the pleasant pictures.

CONCLUSIONS

These preliminary results suggest that severely depressed patients may respond to some pleasant stimuli as if they are aversive, possibly because such stimuli are seen as signals of frustrative nonreward.

Anhedonia and blunted affect in major depressive disorder

The relation between anhedonia and affective flattening was studied in 61 normal subjects and 61 major depressives. Affective flattening and anhedonia were defined by the following self-rating scales: Fawcett-Clark Pleasure Capacity Scale (FCPCS), Hardy Displeasure Capacity Scale (HDCS), FCPCS-PP (subscale of physical pleasure), and HDCS-PD (subscale of physical displeasure). The depressives are more sensitive to displeasure and more anhedonic than controls. Concerning physical stimulations (FCPCS-PP and HDCS-PD) in the depressed group, anhedonia and affective flattening are not linked, suggesting that physical anhedonia is not secondary to low emotional reactivity (affective flattening) and constitutes an independent dimension.

Psychometric properties of scales for the measurement of psychosocial variables associated with depression in adolescence

In preparation for a community-based study of depression in adolescence, several point studies were conducted with samples of adolescents. The purpose of these studies was to evaluate the reliability and association with depression of several instruments when used with older (14- to 18-year-old) adolescents. These instruments included measures of cognitions, body image, self-esteem, self-awareness, social interactions with peers and family, social support, micro- and macrostressful life events, anxiety and tension, positive affect, antisocial or oppositional behaviour, suicidal ideation, and vocabulary. The internal consistency reliability and stability of most of the instruments were satisfactory. In addition, most instruments were associated with a measure of depression, Radloff's Center for Epidemiological Studies-Depression Scale. Several of the scales were successfully abbreviated using techniques based on factor analysis and item analysis.

Cognitive functioning in depression: a review of theory and research

This paper reviews recent research into cognitive functioning in depression, with particular reference to the theories of Lewinsohn, Beck, Seligman and Klein. The major cognitive changes in depression are a decrease in the ability to maintain concentration and effort, and an increase in the relative salience of aversive events and memories, with a corresponding decrease in the salience of pleasant events. There is as yet little evidence to support the view that depressions arise out of pre-existing depressive attitudes. Attention is drawn to the heterogeneity of depressive disorders, and the significance of the endogenous/non-endogenous distinction is discussed.

Motivational deficit in depression: people's expectations x outcomes' impacts

Concludes that depression consists of low reward motivation and high punisher motivation. The argument is as follows: Clinical observation and research agree that depression is primarily a motivational deficit. Learning theories agree that motivation consists of both the organism's expectations and the outcome's impact (value or aversiveness), i.e., motivation = expectation X impact. Popular theories and research agree that depressed people's expectations and their impacts differ from those of nondepressed people. Depressed people often expect few rewards and many punishers, and the impact of rewards is low while that of punishers is high. By substituting known expectancies and impacts into the motivation equation, it becomes clear that depressed people suffer a motivational deficit. A specific deduction is that depressed people exhibit their most severe motivational deficits in ambiguous social situations. This deduction generates the hypothesis that in ambiguous social situations, depressed people should engage in few instrumental, operant behaviors, but many escape and avoidance behaviors.

Unpleasant and pleasant events, and mood

Investigated the relationships between the daily occurrence of aversive events, depressed mood, and the enjoyment of pleasant events in a sample of 21 depressed patients. Participants were assessed pre-, post-, and 1 month after treatment, on the Pleasant Events Schedule, The Unpleasant Events Schedule, MMPI, Beck Depression Inventory and Grinker Interview Checklist. During treatment participants rated their mood and also indicated the occurrence and degree of (un)pleasantness for 80 of their most pleasant and for 80 of their most unpleasant events each day over a 42-day period. Significant associations were found between depressed mood and unpleasant events, and between unpleasant events and the pleasantness of pleasant events. There was also a significant decrease in experienced aversiveness concomitant with clinical improvement.

A multidisciplinary approach to the expression of pain in psychic depression

The expression of cold pressor pain was measured by recording simultaneously verbal magnitude estimates, heart rates, and facial displays of 16 recently hospitalized depressed patients, and 16 nondepressed adults. Independence of the two groups for the depression factor was verified using the Hamilton Scale for Depression and the 100-mm line self-rating scale. Verbal responses and amount of time the ice bath was tolerated, as well as heart-rate measures, indicated that depressed individuals were significantly more sensitive to the pain stimulus. However, this elevated intolerance to pain was not reflected by marked changes of facial display. Reasons for this discrepancy are discussed. Nondepressed subjects, although clearly able to verbalize intensity of pain, were much less reactive to the pain along all dimensions.

Conceptualizing depression and its treatment: comparison of psychoanalytic and behavioral approaches

A comparison of behavioral and more traditional approaches to understanding and modifying depressed behavior is offered. Reports citing the applicability of behavioral techniques to therapy with depressed persons are summarized. A consideration of what behavioral principles might underlie more traditional approaches appears to be a helpful step in defining more productive treatment modes for this disorder.