How to study psychological mechanisms of mania? A systematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder

INTRODUCTION

Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement.

METHODS

A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology.

RESULTS

A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and-attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used.

CONCLUSION

There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.

Associations between daily affective experiences, trait and daily rumination on negative and positive affect: a diary study

BACKGROUND

Rumination has mostly been studied in relation to depression, however, it may also occur in response to positive emotions (i.e., positive rumination) and therefore may be a protective factor related to the maintenance of positive mood.

OBJECTIVE

We hypothesized that daily positive and negative affect would be associated with daily positive and negative rumination even after controlling for trait-level rumination.

METHOD

We carried out a diary study with university students (n = 178), where participants had to answer short surveys online about their daily affect and daily rumination every evening for 10 days. We analyzed our data with multilevel regression in R.

RESULTS

Daily positive and negative affect were significantly associated with daily negative and positive rumination, while trait-level rumination scores were not. Daily and trait-level rumination were moderately correlated (r = 0.333-0.440).

CONCLUSIONS

Our findings highlight that daily rumination plays a more significant role in daily emotional experiences than trait rumination across positive and negative valence domains. Daily negative affect appears to be more closely related to higher daily negative rumination than the lack of daily positive rumination, which could be relevant for intervention strategies.

Assessing Emotion Regulation Difficulties Across Negative and Positive Emotions: Psychometric Properties and Clinical Applications of the Perth Emotion Regulation Competency Inventory in the Chinese Context

Background

Abnormalities of regulating positive and negative emotion have been documented in patients with mental disorders. Valid and reliable psychological instruments for measuring emotion regulation across different valences are needed. The Perth Emotion Regulation Competency Inventory (PERCI) is a 32-item self-report measure recently developed to compressively assess emotion regulation ability across both positive and negative valences.

Purpose

This study aimed to validate the Chinese PERCI in a large non-clinical sample and examine the clinical utility in patients with major depressive disorder (MDD).

Methods

The Chinese PERCI was administered to 1090 Chinese participants (mean age = 20.64 years, 773 females). The factor structure, internal consistency, test-retest reliability, convergent validity, concurrent validity, and predictive validity were examined. Moreover, a MDD group (n = 50) and a matched healthy control group (n = 50) were recruited. Group comparisons and the linear discriminant analysis were conducted to assess the clinical relevance of the PERCI.

Results

Confirmatory factor analysis supported the intended eight-factor structure of the PERCI in the Chinese population. The PERCI showed high internal consistency, test-retest reliability, as well as good convergent and concurrent validity. The MDD group had significantly higher PERCI scores than the healthy control group. Linear discriminant function comprised of the eight factors successfully distinguish patients with MDD from their matched controls.

Conclusion

The Chinese version of the PERCI is a valid and reliable instrument to compressively measure emotion regulation across positive and negative valences in the general Chinese population and patients with depression.

Alexithymia profiles and depression, anxiety, and stress

BACKGROUND

Alexithymia is a multidimensional trait comprised of difficulties identifying feelings, difficulties describing feelings, and externally orientated thinking. It is regarded as an important risk factor for emotional disorders, but there are presently limited data on each specific facet of alexithymia, or the extent to which deficits in processing negative emotions, positive emotions, or both, are important. In this study, we address these gaps by using the Perth Alexithymia Questionnaire (PAQ) to comprehensively examine the relationships between alexithymia and depression, anxiety, and stress symptoms.

METHODS

University students (N = 1250) completed the PAQ and the Depression Anxiety Stress Scales-21. Pearson correlations, hierarchical regressions, and latent profile analysis were conducted.

RESULTS

All facets of alexithymia, across both valence domains, were significantly correlated with depression, anxiety, and stress symptoms (r = 0.27-0.40). Regression analyses indicated that the alexithymia facets, together, could account for a significant 14.6 %-16.4 % of the variance in depression, anxiety, and stress. Difficulties identifying negative feelings and difficulties identifying positive feelings were the strongest unique predictors across all symptom categories. Our latent profile analysis extracted eight profiles, comprising different combinations of alexithymia facets and psychopathology symptoms, collectively highlighting the transdiagnostic relevance of alexithymia facets.

LIMITATIONS

Our study involved a student sample, and further work in clinical samples will be beneficial.

CONCLUSIONS

Our data indicate that all facets of alexithymia, across both valence domains, are relevant for understanding depression, anxiety, and stress. These findings demonstrate the value of facet-level and valence-specific alexithymia assessments, informing more comprehensive understanding and more targeted treatments of emotional disorder symptoms.

Development and validation of the Emotion Regulation Questionnaire - Positive/Negative (ERQ-PN): Does the target of emotion regulation matter?

The Emotion Regulation Questionnaire (ERQ) assesses emotion regulation strategies, particularly expressive suppression and cognitive reappraisal. However, the ERQ does not discern between regulating positive vs. negative emotions. Recent research suggests that suppression and reappraisal can impact mental health differently when targeting positive vs negative emotions. We developed and validated the Emotion Regulation Questionnaire - Positive/Negative (ERQ-PN), designed to measure positive and negative forms of suppression and reappraisal strategies. We recruited 963 participants (female = 478) through Prolific.com and administered the ERQ-PN. Participants had an average age of 45 years and were predominantly White (74%) and heterosexual (84%). Structural validity was assessed through confirmatory factor analyses. Model fit was estimated using the comparative fit index and the root-mean-square error of approximation. We also used the Bayesian information criterion to compare the fit of different models. Overall, participants used reappraisal more often to decrease negative emotions (vs. increasing positive) and leaned toward using suppression more for negative (vs. positive) emotions. These analyses revealed that the four-factor model (Model 2) delineating four latent variables (positive reappraisal, negative reappraisal, positive suppression, and negative suppression) had a good fit (RMSEA = 0.07, CFI = 0. 97, TLI = 0.96, χ 2(98) = 531.28, p < 0.001). An incremental validity assessment revealed that positive and negative reappraisal correlated similarly with related mental health constructs. By contrast, suppression of negative vs. positive emotions was differentially associated to the validators tested. The ERQ-PN represents a valid measure of emotion regulation that accounts for both positive and negative emotions.

Patterns of Neural Network Functional Connectivity Associated With Mania/Hypomania and Depression Risk in 3 Independent Young Adult Samples

Importance

Mania/hypomania is the pathognomonic feature of bipolar disorder (BD). Established, reliable neural markers denoting mania/hypomania risk to help with early risk detection and diagnosis and guide the targeting of pathophysiologically informed interventions are lacking.

Objective

To identify patterns of neural responses associated with lifetime mania/hypomania risk, the specificity of such neural responses to mania/hypomania risk vs depression risk, and the extent of replication of findings in 2 independent test samples.

Design, Setting, and Participants

This cross-sectional study included 3 independent samples of young adults aged 18 to 30 years without BD or active substance use disorder within the past 3 months who were recruited from the community through advertising. Of 603 approached, 299 were ultimately included and underwent functional magnetic resonance imaging at the University of Pittsburgh, Pittsburgh, Pennsylvania, from July 2014 to May 2023.

Main Outcomes and Measures

Activity and functional connectivity to approach-related emotions were examined using a region-of-interest mask supporting emotion processing and emotional regulation. The Mood Spectrum Self-Report assessed lifetime mania/hypomania risk and depression risk. In the discovery sample, elastic net regression models identified neural variables associated with mania/hypomania and depression risk; multivariable regression models identified the extent to which selected variables were significantly associated with each risk measure. Multivariable regression models then determined whether associations in the discovery sample replicated in both test samples.

Results

A total of 299 participants were included. The discovery sample included 114 individuals (mean [SD] age, 21.60 [1.91] years; 80 female and 34 male); test sample 1, 103 individuals (mean [SD] age, 21.57 [2.09] years; 30 male and 73 female); and test sample 2, 82 individuals (mean [SD] age, 23.43 [2.86] years; 48 female, 29 male, and 5 nonbinary). Associations between neuroimaging variables and Mood Spectrum Self-Report measures were consistent across all 3 samples. Bilateral amygdala-left amygdala functional connectivity and bilateral ventrolateral prefrontal cortex-right dorsolateral prefrontal cortex functional connectivity were positively associated with mania/hypomania risk: discovery omnibus χ2 = 1671.7 (P < .001); test sample 1 omnibus χ2 = 1790.6 (P < .001); test sample 2 omnibus χ2 = 632.7 (P < .001). Bilateral amygdala-left amygdala functional connectivity and right caudate activity were positively associated and negatively associated with depression risk, respectively: discovery omnibus χ2 = 2566.2 (P < .001); test sample 1 omnibus χ2 = 2935.9 (P < .001); test sample 2 omnibus χ2 = 1004.5 (P < .001).

Conclusions and Relevance

In this study of young adults, greater interamygdala functional connectivity was associated with greater risk of both mania/hypomania and depression. By contrast, greater functional connectivity between ventral attention or salience and central executive networks and greater caudate deactivation were reliably associated with greater risk of mania/hypomania and depression, respectively. These replicated findings indicate promising neural markers distinguishing mania/hypomania-specific risk from depression-specific risk and may provide neural targets to guide and monitor interventions for mania/hypomania and depression in at-risk individuals.

Interparental Positivity Spillover Theory: How Parents' Positive Relational Interactions Influence Children

Interparental interactions have an important influence on child well-being and development. Yet prior theory and research have primarily focused on interparental conflict as contributing to child maladjustment, which leaves out the critical question of how interparental positive interactions-such as expressed gratitude, capitalization, and shared laughter-may benefit child growth and development. In this article, we integrate theory and research in family, relationship, and affective science to propose a new framework for understanding how the heretofore underexamined positive interparental interactions influence children: interparental positivity spillover theory (IPST). IPST proposes that, distinct from the influence of conflict, interparental positive interactions spill over into children's experiences in the form of their (a) experience of positive emotions, (b) beneficially altered perceptions of their parents, and (c) emulation of their parents' positive interpersonal behaviors. This spillover is theorized to promote beneficial cognitive, behavioral, social, and physiological outcomes in children in the short term (i.e., immediately after a specific episode of interparental positivity, or on a given day) as well as cumulatively across time. As a framework, IPST generates a host of novel and testable predictions to guide future research, all of which have important implications for the mental health, well-being, and positive development of children and families.

Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.

The Perth Empathy Scale: Psychometric Properties of the Polish Version and Its Mental Health Correlates

The Perth Empathy Scale (PES) is a 20-item self-report questionnaire that assesses people's ability to recognize emotions in others (i.e., cognitive empathy) and vicariously experience other's emotions (i.e., affective empathy), across positive and negative emotions. Originally developed in English, the aim of our study was to introduce the first Polish version of the PES and test its psychometric performance. Our sample was 318 people (184 females, 134 males) with ages ranging from 18 to 77. The factor structure was verified with confirmatory factor analysis. Reliability was tested in terms of internal consistency and test-retest reliability. To explore convergent, divergent, and discriminant validity, we examined relationships between the PES and measures of depression, anxiety, and emotional intelligence. It was shown that the scale was characterized by the intended four-factor solution, thus supporting factorial validity. The internal consistency reliability was also good and test-retest reliability was moderate. The convergent, divergent, and discriminant validity were strong. The clinical importance of assessing affective empathy across both positive and negative emotions was supported. Overall, our results therefore suggest that the Polish version of the PES has strong psychometric performance and clinical relevance as a measure of the multidimensional empathy construct.

How do bipolar disease states affect positive and negative emotion processing? Insights from a meta-analysis on the neural fingerprints of emotional processing

BACKGROUND

Functional magnetic resonance imaging studies on emotion processing in patients with bipolar disorder (BD) show hyperactivity of limbic-striatal brain areas and hypoactivity in inferior frontal areas compared to healthy participants. However, heterogeneous results in patients with different disease states and different valences of emotional stimuli have been identified.

METHODS

To integrate previous results and elucidate the impact of disease state and stimulus valence, we conducted a systematic literature search for journal articles in the Web of Science Core Collection including MEDLINE databases and employed a coordinate-based-meta-analysis of functional-MRI studies comparing emotion processing in BD-patients with healthy participants using seed-based d mapping (SDM) to test for between-subjects-effects. We included 31 studies published before 11/2022 with a total of N = 766 BD-patients and N = 836 controls.

RESULTS

Patients with BD showed hyperactivated regions involved in salience processing of emotional stimuli (e.g., the bilateral insula) and hypoactivation of regions associated with emotion regulation (e.g., inferior frontal gyrus) during emotion processing, compared to healthy participants. A more detailed descriptive analysis revealed a hypoactive (anterior) insula in manic BD-patients specifically for negative in comparison to positive emotion processing.

DISCUSSION

This meta-analysis corroborates the overall tenor of existing literature that patients with BD show an increased emotional reactivity (hyperactivity of salience-processing regions) together with a lower (cognitive) control (hypoactivity of brain areas associated with emotion regulation) over emotional states. Our analysis suggests reduced interoceptive processing of negative stimuli in mania, pointing out the need for longitudinal within-subject analyses of emotion processing.

A Randomized Clinical Trial to Assess the Effect of Medication Therapy Plus tDCS on Problem-solving and Emotion Regulation of Patients with Bipolar Disorder Type I

Objective

This study aims to evaluate the effectiveness of medication therapy combined with transcranial Direct Current Stimulation (tDCS) in improving problem-solving and emotion regulation abilities of patients with bipolar disorder (BD) type I.

Methods

This is a randomized clinical trial conducted on 30 patients with BD I, randomly assigned into two groups of Medication (n = 15, receiving mood stabilizers including 2-5 tablets of lithium 300 mg, sodium valproate 200 mg, and carbamazepine 200 mg) and Medication + tDCS (n = 15, receiving mood stabilizers plus tDCS with 2 mA intensity over the right dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 minutes). The Tower of London (TOL) test and Emotion Regulation Questionnaire (ERQ) were used for assessments before, immediately, and 3 months after interventions.

Results

There was a significant difference between groups in total ERQ (p = 0.001) and its cognitive reappraisal domain (p = 0.000) which were increased, but the difference was not significant in its expressive suppression domain (p > 0.05). After 3 months, their level decreased. In examining problem-solving variable, the combined therapy could significantly reduce only the total number of errors under TOL test (p = 0.00), but it remained unchanged after 3 months.

Conclusion

Medication therapy plus tDCS is effective in improving problem-solving and emotional regulation (cognitive reappraisal) skills of patients with BD I.

Experiences that matter in bipolar disorder: a qualitative study using the capability, comfort and calm framework

BACKGROUND

When assessing the value of an intervention in bipolar disorder, researchers and clinicians often focus on metrics that quantify improvements to core diagnostic symptoms (e.g., mania). Providers often overlook or misunderstand the impact of treatment on life quality and function. We wanted to better characterize the shared experiences and obstacles of bipolar disorder within the United States from the patient's perspective.

METHODS

We recruited 24 individuals diagnosed with bipolar disorder and six caretakers supporting someone with the condition. Participants were involved in treatment or support services for bipolar disorder in central Texas. As part of this qualitative study, participants discussed their everyday successes and obstacles related to living with bipolar disorder during personalized, open-ended interviews. Audio files were transcribed, and Nvivo software processed an initial thematic analysis. We then categorized themes into bipolar disorder-related obstacles that limit the patient's capability (i.e., function), comfort (i.e., relief from suffering) and calm (i.e., life disruption) (Liu et al., FebClin Orthop 475:315-317, 2017; Teisberg et al., MayAcad Med 95:682-685, 2020). We then discuss themes and suggest practical strategies that might improve the value of care for patients and their families.

RESULTS

Issues regarding capability included the struggle to maintain identity, disruptions to meaningful employment, relationship loss and the unpredictable nature of bipolar disorder. Comfort related themes included the personal perception of diagnosis, social stigma and medication issues. Calm themes included managing dismissive doctors, finding the right psychotherapist and navigating financial burdens.

CONCLUSIONS

Qualitative data from patients with bipolar disorder helps identify gaps in care or practical limitations to treatment. When we listen to these individuals, it is clear that treatments must also address the unmet psychosocial impacts of the condition to improve patient care, capability and calm.

Emotion regulation in bipolar disorder type-I: multivariate analysis of fMRI data

BACKGROUND

Bipolar disorder type-I (BD-I) patients are known to show emotion regulation abnormalities. In a previous fMRI study using an explicit emotion regulation paradigm, we compared responses from 19 BD-I patients and 17 matched healthy controls (HC). A standard general linear model-based univariate analysis revealed that BD patients showed increased activations in inferior frontal gyrus when instructed to decrease their emotional response as elicited by neutral images. We implemented multivariate pattern recognition analyses on the same data to examine if we could classify conditions within-group as well as HC versus BD.

METHODS

We reanalyzed explicit emotion regulation data using a multivariate pattern recognition approach, as implemented in PRONTO software. The original experimental paradigm consisted of a full 2 × 2 factorial design, with valence (Negative/Neutral) and instruction (Look/Decrease) as within subject factors.

RESULTS

The multivariate models were able to accurately classify different task conditions when HC and BD were analyzed separately (63.24%-75.00%, p = 0.001-0.012). In addition, the models were able to correctly classify HC versus BD with significant accuracy in conditions where subjects were instructed to downregulate their felt emotion (59.60%-60.84%, p = 0.014-0.018). The results for HC versus BD classification demonstrated contributions from the salience network, several occipital and frontal regions, inferior parietal lobes, as well as other cortical regions, to achieve above-chance classifications.

CONCLUSIONS

Our multivariate analysis successfully reproduced some of the main results obtained in the previous univariate analysis, confirming that these findings are not dependent on the analysis approach. In particular, both types of analyses suggest that there is a significant difference of neural patterns between conditions within each subject group. The multivariate approach also revealed that reappraisal conditions provide the most informative activity for differentiating HC versus BD, irrespective of emotional valence (negative or neutral). The current results illustrate the importance of investigating the cognitive control of emotion in BD. We also propose a set of candidate regions for further study of emotional control in BD.

Temporal and contemporaneous network structures of affect and physical activity in emotional disorders

BACKGROUND

High negative affect, low positive affect, and limited physical activity figure prominently in psychopathology, but little is known about the interrelatedness of affect and physical activity in emotional disorders.

METHODS

We combined ecological momentary assessment data with a network approach to examine the dynamic relations among positive affect, negative affect, and smartphone-based estimates of physical activity in 34 participants with anxiety and depressive disorders over a 2-week period.

RESULTS

In the contemporaneous networks, the positive affect nodes exhibited greater overall strength centrality than negative affect nodes. The temporal networks indicated that the negative affect node 'sadness' exhibited the greatest out-strength centrality. Furthermore, physical activity was unconnected to the affect nodes in either the temporal or contemporaneous networks.

CONCLUSIONS

Whereas positive affect plays a greater role in the contemporaneous experience of emotions, negative affect contributes more so to future affective states.

Risk for bipolar spectrum disorders associated with positive urgency and orbitofrontal cortical grey matter volume

Bipolar spectrum disorders (BSDs) are associated with reward hypersensitivity, impulsivity, and structural abnormalities within the brain's reward system. Using a behavioral high-risk study design based on reward sensitivity, this paper had two primary objectives: 1) investigate whether elevated positive urgency, the tendency to act rashly when experiencing extreme positive affect, is a risk for or correlate of BSDs, and 2) examine the nature of the relationship between positive urgency and grey matter volume in fronto-striatal reward regions, among individuals at differential risk for BSD. Young adults (ages 18-28) screened to be moderately reward sensitive (MReward; N = 42), highly reward sensitive (HReward; N = 48), or highly reward sensitive with a lifetime BSD (HReward + BSD; N = 32) completed a structural MRI scan and the positive urgency subscale of the UPPS-P scale. Positive urgency scores varied with BSD risk (MReward < HReward < HReward + BSD; ps≤0.05), and positive urgency interacted with BSD risk group in predicting lateral OFC volume (p <.001). Specifically, the MReward group showed a negative relationship between positive urgency and lateral OFC volume. By contrast, there was no relationship between positive urgency and lateral OFC grey matter volume among the HReward and HReward + BSD groups. The results suggest that heightened trait positive urgency is a pre-existing vulnerability for BSD that worsens with illness onset, and there is a distinct relationship between positive urgency and lateral OFC volume among individuals at high versus low risk for BSD. These findings have implications for understanding the expression and development of impulsivity in BSDs.

The pursuit of happiness: A reinforcement learning perspective on habituation and comparisons

In evaluating our choices, we often suffer from two tragic relativities. First, when our lives change for the better, we rapidly habituate to the higher standard of living. Second, we cannot escape comparing ourselves to various relative standards. Habituation and comparisons can be very disruptive to decision-making and happiness, and till date, it remains a puzzle why they have come to be a part of cognition in the first place. Here, we present computational evidence that suggests that these features might play an important role in promoting adaptive behavior. Using the framework of reinforcement learning, we explore the benefit of employing a reward function that, in addition to the reward provided by the underlying task, also depends on prior expectations and relative comparisons. We find that while agents equipped with this reward function are less happy, they learn faster and significantly outperform standard reward-based agents in a wide range of environments. Specifically, we find that relative comparisons speed up learning by providing an exploration incentive to the agents, and prior expectations serve as a useful aid to comparisons, especially in sparsely-rewarded and non-stationary environments. Our simulations also reveal potential drawbacks of this reward function and show that agents perform sub-optimally when comparisons are left unchecked and when there are too many similar options. Together, our results help explain why we are prone to becoming trapped in a cycle of never-ending wants and desires, and may shed light on psychopathologies such as depression, materialism, and overconsumption.

Even in favorable circumstances, we often find it hard to remain happy with what we have. One might enjoy a newly bought car for a season, but over time it brings fewer positive feelings and one eventually begins dreaming of the next rewarding thing to pursue. Here, we present a series of computational simulations that suggest these presumable “flaws” might play an important role in promoting adaptive behavior. We explore the value of prior expectations and relative comparisons as a useful reward signal and find that across a wide range of environments, these features help an agent learn faster and adapt better to changes in the environment. Our simulations also highlight scenarios when these relative features can be harmful to decision-making and happiness. Together, our results help explain why we have the propensity to keep wanting more, even if it contributes to depression, materialism, and overconsumption.

Parent Emotion Socialization and Positive Emotions in Child and Adolescent Clinical Samples: A Systematic Review and Call to Action

The majority of the emotion socialization behaviors (ESB) literature has focused on community samples and socialization of negative emotions. However, it is becoming increasingly apparent that ESB are also critical in setting the foundations for the healthy development of positive emotions, with implications for developmental psychopathology. We conducted a systematic review of research examining parent ESB and youth positive emotions in clinical child and adolescent samples. A literature search was conducted in March 2021, resulting in 563 abstracts being reviewed. Two reviewers independently screened the titles and abstracts to identify relevant papers, with 53 articles being reviewed in full. Seven articles (four cross-sectional and correlational, three intervention) were included in the current review, of which one was with an internalizing sample, three were with an externalizing sample, and three were with a neurodevelopmental disorder sample. Results varied regarding the role of parent ESB in youth positive emotions across clinical populations. In correlational studies, minimal evidence was found for the association between parent ESB and youth positive emotions, but across the three intervention studies, there was evidence that both parent ESB and children's positive emotions can be improved through intervention. We present a preliminary model of relations between youth psychopathology, parent ESB, and child positive emotions, with consideration of potential moderators of links between ESB and positive emotions. Finally, we discuss limitations of the existing body of research, and offer specific recommendations for future research directions.

Positive Emotion Dysregulation in Posttraumatic Stress Disorder

Although PTSD is associated with both emotion regulation (ER) difficulties and persistent difficulties experiencing positive emotions, research concerning positive ER in PTSD is still scarce. We aimed to clarify whether PTSD patients show dysfunctional responses to positive emotions and whether positive ER is associated with PTSD symptom severity. PTSD patients (N = 59) were compared to healthy controls (HC, N = 58) with respect to their self-reported regulation of positive and negative emotions. We used the Responses to Positive Affect Questionnaire to assess positive ER and the Difficulties in Emotion Regulation Scale and Response Styles Questionnaire to assess negative ER. PTSD patients showed deficient negative as well as deficient positive ER as compared to HC. Both dampening of positive emotions as well as positive rumination were associated with self-reported symptom severity. Furthermore, dampening contributed to the prediction of PTSD symptom severity beyond depressive symptoms and negative rumination. This study supports and expands previous findings of dysfunctional positive ER in PTSD. Further research is needed to clarify whether deficits in positive ER contribute to the onset and maintenance of PTSD. If so, therapeutic approaches should aim to help PTSD patients build up adequate skills to handle positive emotions in PTSD.

An Eye Tracking and Event-Related Potentials Study With Visual Stimuli for Adolescents Emotional Issues

BACKGROUND

Psychological issues are common among adolescents, which have a significant impact on their growth and development. However, the underlying neural mechanisms of viewing visual stimuli in adolescents are poorly understood.

MATERIALS AND METHODS

This study applied the Chinese version of the DSM-V self-assessment scales to evaluate 73 adolescents' psychological characteristics for depressive and manic emotional issues. Combined with eye-tracking and event-related potential (ERP), we explored the characteristics of their visual attention and neural processing mechanisms while freely viewing positive, dysphoric, threatening and neutral visual stimuli.

RESULTS

Compared to controls, adolescents with depressive emotional tendencies showed more concentrated looking behavior with fixation distribution index than the controls, while adolescents with manic emotional tendencies showed no such trait. ERP data revealed individuals with depressive tendencies showed lower arousal levels toward emotional stimuli in the early stage of cognitive processing (N1 amplitude decreased) and with prolonged reaction time (N1 latency increased) than the control group. We found no significant difference between the manic group and the control group. Furthermore, the depression severity scores of the individuals with depressive tendencies were negatively correlated with the total fixation time toward positive stimuli, were negatively correlated with the fixation distribution index toward threatening stimuli, and were positively correlated with the mean N1 amplitudes while viewing dysphoric stimuli. Also, for the individuals with depressive tendencies, there was a positive correlation between the mean N1 amplitudes and the fixation time on the area of interest (AOI) while viewing dysphoric stimuli. For the individuals with manic tendencies, the manic severity scores of the individuals with manic tendencies were positively correlated with the total fixation time toward the positive stimuli. However, no significant correlations were found between the manic severity scores and N1 amplitudes, and between N1 amplitudes and eye-tracking output variables.

CONCLUSION

This study proposes the application of eye-tracking and ERP to provide better biological evidence to alter the neural processing of emotional stimuli for adolescents with emotional issues.

Current Progress and Future Directions for Theory and Research on Savoring

As research on savoring has increased dramatically since publication of the book Savoring: A New Model of Positive Experience (Bryant and Veroff, 2007), savoring has gradually become a core concept in positive psychology. I begin by reviewing the evolution of this concept, the development of instruments for assessing savoring ability and savoring strategies, and the wide range of applications of savoring in the psychosocial and health sciences. I then consider important directions for future theory and research. To advance our understanding of how naturalistic savoring unfolds over time, future work should integrate the perceptual judgments involved in not only the later stages of attending to and regulating positive experience (where past research has concentrated), but also the initial stages of searching for and noticing positive stimuli. Whereas most research has investigated reactive savoring, which occurs spontaneously in response to positive events or feelings, future work is also needed on proactive savoring, which begins with the deliberate act of seeking out or creating positive stimuli. To advance the measurement of savoring-related constructs, I recommend future work move beyond retrospective self-report methods toward the assessment of savoring as it occurs in real-time. The development of new methods of measuring meta-awareness and the regulation of attentional focus are crucial to advancing our understanding of savoring processes. I review recent research on the neurobiological correlates of savoring and suggest future directions in which to expand such work. I highlight the need for research aimed at unraveling the developmental processes through which savoring skills and deficits evolve and the role that savoring impairments play in the etiology and maintenance of psychopathology. Research is also needed to learn more about what enhances savoring, and to disentangle how people regulate the intensity versus duration of positive emotions. Finally, I encourage future researchers to integrate the study of anticipation, savoring the moment, and reminiscence within individuals across time.

The integrated constructionist approach to emotions: A theoretical model for explaining alterations to positive emotional experiences in the aftermath of trauma

Prior research has assumed that individuals with PTSD find positive emotions enjoyable and rewarding. While intuitive, this assumption is problematic for a number of reasons. A growing body of literature suggests that positive emotions can be unwanted and uncomfortable experiences for many people, particularly individuals with PTSD. Yet our empirical and theoretical models of PTSD do not adequately account for this complexity. Throughout the following pages, we argue that the same behavioral processes that have been heavily researched and associated with fear and avoidance of negative emotions and PTSD can be extended to positive emotions as well. We propose the integrated constructionist approach to emotions, which integrates learning theory principles with a constructionist approach and suggest that trauma experiences lead to a shift in the evaluation, interpretation, and labeling of an individual's internal experiences. This evaluative shift results in generalized patterns of emotional responding characterized by efforts to downregulate internal stimuli that were previously defined as positive and may have been appetitive pre-trauma. We subsequently highlight the theoretical, empirical, and clinical importance of taking an idiographic approach to understanding and working with emotions among individuals with PTSD.

No group differences in Traditional Economics Measures of loss aversion and framing effects in bipolar I disorder

Bipolar disorder (BD) is associated with impaired decision making, yet few studies have adopted paradigms from behavioral economics to decompose which, if any, aspects of decision making may be impacted. This may be particularly relevant for decision-making processes relevant to known difficulties with emotive dysfunction and corresponding reward dysregulation in BD. Participants with bipolar I disorder (BD; n = 44) and non-psychiatric healthy controls (CTL; n = 28) completed three well-validated behavioral economics decision making tasks via a remote-based survey, including loss aversion and framing effects, that examined sensitivity to probabilities and potential gains and losses in monetary and non-monetary domains. Consistent with past work, we found evidence of moderate loss aversion and framing effects across all participants. No group differences were found in any of the measures of loss aversion or framing effects. We report no group differences between bipolar and non-psychiatric groups with respect to loss aversion and framing effects using a remote-based survey approach. These results provide a framework future studies to explore similar tasks in clinical populations and suggest the context and degree to which decision making is altered in BD may be rooted in a more complex cognitive mechanism that warrants future research.

Assessing Emotion Regulation Ability for Negative and Positive Emotions: Psychometrics of the Perth Emotion Regulation Competency Inventory in United States Adults

People regulate both negative and positive emotions, and their ability to do this successfully is a cornerstone of adaptive psychological functioning. However, few measures have been available to assess emotion regulation ability across both valence domains. The Perth Emotion Regulation Competency Inventory (PERCI) was recently developed for this purpose. Here we present the first psychometric study of the PERCI in the United States (N = 508). Confirmatory factor analyses supported the intended eight-factor structure, which was invariant across age, gender, and education. PERCI scores had high internal consistency, and were associated with measures of psychopathology, emotional reactivity, and emotion regulation strategies in expected ways. These observed relationships between the PERCI and various regulation strategies may serve to establish a profile of what strategy patterns characterize differences in emotion regulation ability. Overall, the PERCI had strong psychometrics. Its capacity to assess both valence domains should enable more comprehensive assessments of emotion regulation ability.

Interactions and implications of Fuzzy-Trace theory for risk taking behaviors in bipolar disorder

BACKGROUND

According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, "gist" reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, "verbatim" reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist "values" mediate the role of "categorical gist". Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships.

METHODS

Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception.

RESULTS

Mediational models indicated that (a) Gist Values mediated Categorical Gist's effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not.

LIMITATIONS

Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the inpatient generalizability of the results.

CONCLUSIONS

The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT's functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.

Relationships between dimensions of emotional experience, rumination, and nonsuicidal self-injury: An application of the Emotional Cascade Model

OBJECTIVE

The Emotional Cascade Model posits that nonsuicidal self-injury (NSSI) functions to distract from cascades of intense negative emotion and rumination. We investigated the moderating role of rumination in the relationships between reactivity, intensity, and perseveration of emotion and NSSI.

METHOD

University students (N = 992) completed self-report measures of self-injury, emotional reactivity, intensity and perseveration, and rumination.

RESULTS

Together, the dimensions of negative emotion were associated with NSSI, but none contributed unique variance. For positive emotion, reactivity was negatively associated with history of self-injury and perseveration was negatively associated with frequency of the behaviour. Rumination was associated with NSSI, but did not moderate associations between the dimensions of negative emotion and self-injury. Rumination moderated the relationship between perseveration of positive emotion and history of NSSI, such that it was only significant at high levels of rumination.

CONCLUSION

Findings highlight the importance of dimensions of positive emotion in understanding self-injury.

Deficits in explicit emotion regulation in bipolar disorder: a systematic review

Background

This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients.

Methods

To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state.

Results

In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks.

Conclusion

We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.

Processing of infant emotion in mothers with mood disorders and implications for infant development

BACKGROUND

Atypical neurocognitive responses to emotional stimuli are core features of unipolar depression (UD) and bipolar disorder (BD). For mothers with these mood disorders, this may influence interactions with their infants and consequently infant development. The study aimed to investigate psychophysiological and cognitive responses to infant emotional stimuli, and their relation to mother-infant interaction and infant development, in mothers with BD or UD in full or partial remission.

METHODS

Four months after birth, mothers' cognitive responses to emotional infant stimuli were assessed with computerized tasks, while their facial expressions, galvanic skin responses (GSR), gazes, and fixations were recorded. Infant development and mother-infant interactions were also assessed.

RESULTS

We included 76 mothers: 27 with BD, 13 with UD, and 36 without known psychiatric disorders, and their infants. Mothers with BD and UD were in full or partial remission and showed blunted GSR and spent less time looking at infant stimuli (unadjusted p values < 0.03). Mothers with BD showed subtle positive neurocognitive biases (unadjusted p values<0.04) and mothers with UD showed negative biases (unadjusted p values < 0.02). Across all mothers, some measures of atypical infant emotion processing correlated with some measures of delays in infant development and suboptimal mother-infant interaction (unadjusted p values<0.04).

CONCLUSIONS

Mothers with mood disorders in full or partial remission showed atypical cognitive and psychophysiological response to emotional infant stimuli, which could be associated with mother-infant interactions and infant development. The study is explorative, hypothesis generating, and should be replicated in a larger sample. Investigation of the long-term implications of reduced maternal sensitivity is warranted.

Critical considerations for the positive memory-posttraumatic stress disorder model

Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.

Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder

INTRODUCTION

Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use.

OBJECTIVE

The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse.

METHOD

Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women).

RESULTS

Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse.

CONCLUSIONS

Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.

Social cognition in first-degree relatives of bipolar disorder: Theory of Mind and nonverbal sensitivity

Social cognition might be impaired in first degree relatives (FDR) of BD but existing research shows controversial results about social cognitive impairments in this population. The aim of this study was to assess Theory of Mind (ToM) and nonverbal sensitivity in FDR of BD and compare the results with those of two groups of persons with remitted bipolar disorder (BD), type I and II, and a control group. Social cognitive ability was examined in first degree relatives of BD, with a biological parent, offspring or sibling diagnosed with the disorder. For this study, 37 FDRs of bipolar patients, 37 BD I, 40 BD II and 40 control participants were recruited. Social cognition was explored by means of the Reading the Mind in the Eyes Test and the MiniPONS. Results showed a significant impairment in FDR of BD in the ToM task, but not in nonverbal sensitivity. Performance of FDRs in social cognition is better than that of BDs (either type I or type II) but worse when compared with that of healthy individuals without a family history of psychiatric disorders. Nevertheless, no differences were found between BD I and BD II groups. Males and older participants showed a worse performance in all groups. Group family therapy with FDRs of BD might include training in the recognition of nonverbal cues, which might increase the understanding of their familiars with BD, in order to modify communication abilities.

The neuroscience of positive emotions and affect: Implications for cultivating happiness and wellbeing

This review paper provides an integrative account regarding neurophysiological correlates of positive emotions and affect that cumulatively contribute to the scaffolding for happiness and wellbeing in humans and other animals. This paper reviews the associations among neurotransmitters, hormones, brain networks, and cognitive functions in the context of positive emotions and affect. Consideration of lifespan developmental perspectives are incorporated, and we also examine the impact of healthy social relationships and environmental contexts on the modulation of positive emotions and affect. The neurophysiological processes that implement positive emotions are dynamic and modifiable, and meditative practices as well as flow states that change patterns of brain function and ultimately support wellbeing are also discussed. This review is part of "The Human Affectome Project" (http://neuroqualia.org/background.php), and in order to advance a primary aim of the Human Affectome Project, we also reviewed relevant linguistic dimensions and terminology that characterizes positive emotions and wellbeing. These linguistic dimensions are discussed within the context of the neuroscience literature with the overarching goal of generating novel recommendations for advancing neuroscience research on positive emotions and wellbeing.

A pilot investigation of emotional regulation difficulties and mindfulness-based strategies in manic and remitted bipolar I disorder and major depressive disorder

Background

Both bipolar disorder and major depressive disorder are characterized by difficulties in emotion regulation. Little is known about which specific emotion regulatory patterns may be transdiagnostic versus disorder specific, and how such patterns change as a function of current mood states.

Methods

This preliminary investigation examined specific patterns of self-reported trait emotion regulation difficulties and mindfulness-based regulations strategies across four groups: remitted adults with bipolar I disorder (BD-remitted; n = 32), currently manic adults with bipolar I disorder (BD-manic; n = 19), remitted adults with major depressive disorder (MDD-remitted; n = 32), and healthy controls (CTL; n = 30).

Results

All three clinical groups reported significantly greater difficulties with emotion regulation and decreased overall mindfulness-based strategies.

Conclusions

These results suggest that increased emotion regulation difficulties, decreased mindfulness, and increased emotion-driven impulsivity may be transdiagnostic across mood disorders and states, and that impulsivity may be particularly impaired during periods of mania.

Cognitive processing of infant stimuli in pregnant women with and without affective disorders and the association to postpartum depression

Pregnancy and childbirth are among the strongest risk factors for depression but the neurocognitive mechanisms underlying this enhanced risk are unknown. This study investigated emotional and non-emotional cognition in 57 pregnant women with or without an affective disorder during their third trimester, and the association between cognitive biases and subsequent postpartum depression (PPD). Of the pregnant women, 22 had a diagnosis of unipolar disorder (UD) and seven of bipolar disorder (BD) in full or partial remission, while 28 had no history of affective disorder. We included a control group of 29 healthy non-pregnant women. First, participants were interviewed, completed non-emotional and emotional cognitive tests and lastly filled out questionnaires. The participants were assessed two times after birth: at a home visit shortly after birth, and with a telephone interview to assess PPD in the first six months after birth. Healthy pregnant women rated infant cries less negatively than non-pregnant women, possibly reflecting preparation for motherhood. Pregnant women with UD exhibited a negative bias in ratings of infant cries, whereas pregnant women with BD showed a positive bias in ratings of infant happy faces and recognition of adult facial expressions. Across all pregnant women, more negative ratings of infant cries were associated with enhanced risk of PPD. Negatively biased perception of infant cries during pregnancy may thus signal vulnerability toward PPD.

Distraction and expressive suppression strategies in down-regulation of high- and low-intensity positive emotions

Emotion intensity is important for emotional regulation process. The studies in this literature, however, have generally focused on the down-regulation of negative emotions. Few studies have examined the down-regulation of positive emotions. Distraction and expressive suppression belong to disengagement strategies, which direct coping efforts away from emotions. Participants are more likely to select distraction and expressive suppression when motivated to down-regulate their emotions. Therefore, this study aimed to assess the impact of emotional intensity on down-regulating positive emotions via distraction and expressive suppression. The event-related potentials (ERPs) of college students were recorded while they were instructed to down-regulate positive emotions using expressive suppression or distraction versus free viewing when exposed to high- and low-intensity pleasant stimuli. Subsequently, participants were instructed to rate their positive experience using a 9-point scale. Supporting our predictions, behavioral results showed that both strategies could dramatically reduce high-intensity positive experience relative to viewing, and distraction led to a larger reduction of high-intensity positive experience than expressive suppression. Both strategies could not decrease low-intensity positive experience relative to viewing. ERP results showed that distraction successfully attenuated the early (500-700 ms) and late (700-1500 ms) stage of late positive potential (LPP) in high-intensity, and in low-intensity it modulated the early (but not late) LPP relative to viewing. Unexpectedly, expressive suppression effectively attenuated the early and late LPP in high- and low-intensity relative to viewing. The findings suggest that expressive suppression and distraction can effectively down-regulate positive emotions; however, distraction is more susceptible to emotional intensity and time.

Associations between hypomania proneness and attentional bias to happy, but not angry or fearful, faces in emerging adults

Mania, the core feature of bipolar disorder, is associated with heightened and positive emotion responding. Yet, little is known about the underlying cognitive processes that may contribute to heightened positive emotionality observed. Additionally, while previous research has investigated positive emotion biases in non-clinical samples, few if any, account for subthreshold clinical symptoms or traits, which have reliably assessed psychopathological risk. The present study compared continuous scores on a widely used self-report measure of hypomania proneness (HPS-48) with a dot-probe task to investigate attentional biases for happy, angry, fearful, and neutral faces among 66 college student participants. Results suggested that hypomania proneness was positively associated with attentional bias towards happy, but not angry or fearful faces. Results remained robust when controlling for positive affect and did not appear to be affected by negative affect or current symptoms of depression, anxiety, and stress. Findings provide insight into potential behavioural markers that co-occur with heightened positive emotional responding and hypomania in emerging adults.

Normal Versus Pathological Mood: Implications for Diagnosis

Is there a clear line between normal and abnormal mood? Studies of manifest and latent structure provide strong support for a continuum that extends from asymptomatic to subsyndromal to syndromal cases of increasing severity. Subsyndromal symptoms are impairing, predict syndrome onset and relapse, and account for more doctor's visits and suicide attempts than the full syndromes, yet they are not recognized in the current classification. For most research and some clinical activities, dimensional diagnoses are recommended, and examples are offered for how such diagnoses could be made. For clinical activities requiring decisions, a multithreshold model is proposed in which both lower (e.g., mild depression, capturing subsyndromal cases) and upper (e.g., major depression, capturing clinically significant cases) diagnostic categories are used to inform clinical care. Beyond its implications for diagnosis, the dimensionality of depression and anxiety has implications for etiology and for research aimed at understanding how emotions become disrupted in psychopathology.

Positive and Negative Activation in the Mood Disorder Questionnaire: Associations With Psychopathology and Emotion Dysregulation in a Clinical Sample

The Mood Disorder Questionnaire is a screening measure for bipolar disorder, previously found to comprise separate Positive and Negative Activation subscales. We sought to replicate these factors and examine their associations with a range of psychopathology. To further explicate the nature of Negative Activation, we examined associations with the Difficulties in Emotion Regulation Scale, a measure of emotion dysregulation. The sample consisted of 1,787 participants from an outpatient treatment facility. Confirmatory factor analysis replicated the existence of Positive and Negative Activation subscales. Logistic regressions, as hypothesized, found that Positive Activation was positively associated only with bipolar disorder, while Negative Activation was associated with almost all disorders. The Impulse and Goals subscales of the Difficulties in Emotion Regulation Scale were uniquely associated with Negative Activation, suggesting it may specifically assess impulsive behavior in emotional situations. The findings suggest that it may be important to attend to both Mood Disorder Questionnaire subscales.

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

Personality and the Expression of Symptomatology in Schizophrenia and Bipolar Disorder

Researchers and clinicians have begun using dimensions rather than categories to classify psychopathology with a reliance on personality questionnaires to tap traits that can inform dimensional characterizations. A neglected concern is whether in severe psychopathology questionnaire-based assessments of personality reflect a lifetime propensity toward a diagnosis, as some personality-psychopathology models posit, or reflect the transient effects of current symptoms, as a complication model of personality-psychopathology would suggest. Accurate characterization of psychopathology is necessary to understand etiology and prescribe clinical care. We studied 127 adults with schizophrenia, schizoaffective, or bipolar disorder who completed well-validated measures of personality, current symptomatology, and lifetime psychopathology. We found that normative personality traits were related to current symptoms but unrelated to lifetime symptomatology, whereas the schizotypal trait of cognitive-perceptual distortions predicted lifetime psychosis severity. Questionnaire-based assessments of normative personality are likely affected by current symptom states and may fail to yield a stable characterization of psychopathology.

Theory of mind in remitted bipolar disorder: Interpersonal accuracy in recognition of dynamic nonverbal signals

A relatively unexplored aspect in bipolar disorder (BD) is the ability to accurately judge other´s nonverbal behavior. To explore this aspect of social cognition in this population is particularly meaningful, as it may have an influence in their social and interpersonal functioning. The aim of this research was to study interpersonal accuracy (IPA) in remitted BDs, that is, the specific skills that fall under the general term Theory of Mind (ToM). Study participants included 119 remitted individuals with BD (70 BD I and 49 BD II), and they were compared with a group of 39 persons diagnosed with unipolar depression (UD) and 119 control participants. The MiniPONS was used to test the whole spectrum of nonverbal cues as facial expressions, body language and voice. Results indicated a superiority of the control group with statistically significant differences both in the performance in the MiniPONS (number of right answers) and in each of the areas evaluated by this test. BD groups, in recognition of the meaning of gestures in face, body and voice intonation, performed significantly worse than controls. ANCOVA analysis controlling the effect of age shows that control group performed significantly better compared to clinical groups, and there were no differences between UD and BD groups. The results indicate a deficit in IPA and suggest that better comprehension of deficiencies in interpersonal accuracy in BD may help to develop new training programs to improve in these patients the understanding of others, which might have a positive impact in their psychosocial functionality, and thus lead to the objective of functional rehabilitation.

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

Anorexia nervosa (AN) is a complex and life-threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self-report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.

The contribution of optimism and hallucinations to grandiose delusions in individuals with schizophrenia

Grandiose delusions (GDs) are defined as false beliefs about having an inflated worth, power, or a special identity which are firmly sustained despite undeniable evidence to the contrary. Although it is the second most commonly encountered delusional beliefs, GDs have received little attention. Thus, in this study, we explored the role of future expectations and sensitivity to reward in GDs in schizophrenia (SZ) disorder. In total, 115 SZ patients completed measures of positive and negative symptoms, sensitivity to reward, depression, and a task in which individuals were asked to estimate the probability that positive, negative and neutral events will occur in the future. Correlation and Linear Regression analyses were performed in order to determine whether sensitivity to reward and future expectations are associated with GDs. Regressions showed that hallucinations and future positive expectations were significantly associated with GDs. In conclusion, the present study showed that higher optimism regarding the future might be important psychological processes associated with the maintenance of GDs in SZ patients. Moreover, it is possible that patients experiencing hallucinations may interpret this phenomenon as a kind of special ability or power, resulting in turn in GDs maintenance. Implications of these findings and directions for future research are discussed.

Confirmatory validation of the factor structure and psychometric properties of the Difficulties in Emotion Regulation Scale-Positive

OBJECTIVES

Emotion dysregulation is a transdiagnostic factor central to the etiology and treatment of various clinical difficulties. Yet, research in this area has focused almost exclusively on emotion dysregulation stemming from negative emotions. The current study confirmed the factor structure of the Difficulties in Emotion Regulation Scale-Positive (DERS-P) and further examined its reliability and validity.

METHOD

Participants in Study 1 were 229 college students (M age = 19.37 years; 66.8% female; 67.2% White). Participants in Study 2 were 353 trauma-exposed community individuals ( M age = 35.77 years; 57.8% female; 71.2% White).

RESULTS

Findings supported the three-factor structure of the DERS-P. Mean levels of the DERS-P scales demonstrated convergent and discriminant validity and differentiated individuals with (vs. without) probable posttraumatic stress disorder, depression, alcohol use, and drug use disorders.

CONCLUSIONS

Findings provide additional support for the factor structure, reliability, and validity of the DERS-P, thereby adding to its clinical utility.