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Alteration of Complex Negative Emotions Induced by Music in Euthymic Patients with Bipolar Disorder

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Alteration of Complex Negative Emotions Induced by Music in Euthymic Patients with Bipolar Disorder Article Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder CHOPPIN, Sabine, et al. Abstract Background Research has shown bipolar disorder to be characterized by dysregulation of emotion processing, including biases in facial expression recognition that is most prevalent during depressive and manic states. Very few studies have examined induced emotions when patients are in a euthymic phase, and there has been no research on complex emotions. We therefore set out to test emotional hyperreactivity in response to musical excerpts inducing complex emotions in bipolar disorder during euthymia. Methods We recruited 21 patients with bipolar disorder (BD) in a euthymic phase and 21 matched healthy controls. Participants first rated their emotional reactivity on two validated self-report scales (ERS and MAThyS). They then rated their music-induced emotions on nine continuous scales. The targeted emotions were wonder, power, melancholy and tension. We used a specific generalized linear mixed model to analyze the behavioral data. Results We found that participants in the euthymic bipolar group experienced more intense complex negative emotions than controls when the musical excerpts induced wonder. Moreover, patients [...] Reference CHOPPIN, Sabine, et al. Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder. Journal of Affective Disorders, 2016, vol. 191, p. 15-23 DOI : 10.1016/j.jad.2015.10.063 PMID : 26605497 Available at: http://archive-ouverte.unige.ch/unige:89656 Disclaimer: layout of this document may differ from the published version. 1 / 1 Journal of Affective Disorders 191 (2016) 15–23 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Research report Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder Sabine Choppin a,b,n,1, Wiebke Trost c,d,nn,1, Thibaut Dondaine a,b, Bruno Millet a,b, Dominique Drapier a,b, Marc Vérin a,e, Gabriel Robert a,b, Didier Grandjean c,d a ‘Behavior and Basal Ganglia’ laboratory (EA 4712), University of Rennes 1, Rennes, France b Psychiatry Unit, Guillaume Régnier Hospital, Rennes, France c ‘Neuroscience of Emotion and Affective Dynamics’ laboratory, Department of Psychology, University of Geneva, Switzerland d Swiss Center for Affective Sciences, University of Geneva, Switzerland e Neurology Unit, Rennes University Hospital, Rennes, France article info abstract Article history: Background: Research has shown bipolar disorder to be characterized by dysregulation of emotion Received 21 July 2015 processing, including biases in facial expression recognition that is most prevalent during depressive and Received in revised form manic states. Very few studies have examined induced emotions when patients are in a euthymic phase, 23 September 2015 and there has been no research on complex emotions. We therefore set out to test emotional hy- Accepted 23 October 2015 perreactivity in response to musical excerpts inducing complex emotions in bipolar disorder during Available online 10 November 2015 euthymia. Keywords: Methods: We recruited 21 patients with bipolar disorder (BD) in a euthymic phase and 21 matched Bipolar disorder healthy controls. Participants first rated their emotional reactivity on two validated self-report scales Complex musical emotion (ERS and MAThyS). They then rated their music-induced emotions on nine continuous scales. The tar- Emotional reactivity geted emotions were wonder, power, melancholy and tension. We used a specific generalized linear Mixed model mixed model to analyze the behavioral data. Results: We found that participants in the euthymic bipolar group experienced more intense complex negative emotions than controls when the musical excerpts induced wonder. Moreover, patients ex- hibited greater emotional reactivity in daily life (ERS). Finally, a greater experience of tension while listening to positive music seemed to be mediated by greater emotional reactivity and a deficit in ex- ecutive functions. Limitations: The heterogeneity of the BD group in terms of clinical characteristics may have influenced the results. Conclusions: Euthymic patients with bipolar disorder exhibit more complex negative emotions than controls in response to positive music. & 2015 Elsevier B.V. All rights reserved. 1. Introduction subsyndromal symptoms, like cognitive impairments (Martinez- Aran et al., 2004) outside acute episodes and they may be one of Patients with bipolar disorder (BD) are generally assumed not the main cause of relapse (Henry et al., 2015). One of them-emo- to show any severe symptoms when they are in a euthymic state. tional reactivity-already seems to have been validated as an ab- However, there is increasing evidence that patients may exhibit normal clinical feature in BD even between episodes. Self-report questionnaires indicate that patients experience higher levels of emotional lability and intensity than controls (Henry et al., 2008b). Researchers have also used emotion induction methods to test n Corresponding author at: ‘Behavior and Basal Ganglia’ laboratory (EA 4712), Comportement et Noyaux Centraux Gris, Université de Rennes 1, Campus de Vil- emotional reactivity in patients, such as showing them positive, lejean-Bât. 40L27, 35033 Rennes Cedex, France. neutral or negative pictures and asking them to assess the sub- nn Corresponding author at: Swiss Center for Affective Sciences, University of jectively felt emotions triggered by the pictures (Dubois et al., Geneva, Campus Biotech, 9, Chemin des Mines, Case Postale 60, CH-1211 Geneva 2012; M’bailara et al., 2009). These studies have shown that, 20, Switzerland. compared with controls, patients with BD experience greater E-mail addresses: [email protected] (S. Choppin), [email protected] (W. Trost). emotional intensity when exposed to neutral faces, even when 1 These authors contributed equally to this work. they are in a euthymic state. However, there has been only limited http://dx.doi.org/10.1016/j.jad.2015.10.063 0165-0327/& 2015 Elsevier B.V. All rights reserved. 16 S. Choppin et al. / Journal of Affective Disorders 191 (2016) 15–23 research on this effect in the auditory modality. Some research on 2. Methods emotional prosody has shown that even patients in remission are selectively impaired on the recognition of emotions expressed by 2.1. Participants human voices (Bozikas et al., 2007; Van Rheenen and Rossell, 2013). However, only basic and discrete emotions have been stu- One group of euthymic patients with BD and one group of HC died so far, and the literature does not provide any information took part in the study. The clinical group included 21 patients with about complex emotion disturbances in BD. BD (5 men, 16 women), all born in France and native French Music is a powerful emotional and ecologically valid tool, and speakers. Their mean (7SE) age was 48.3 years (78.8, ¼ – constitutes an ideal model for studying complex emotional ex- range 33 63). Eighteen were right-handed and three were left- perience. There is already a body of research on music-induced handed, according to the criteria of the Edinburgh Handedness fi 7 experiences in patients who have been diagnosed with depression Inventory (Old eld, 1971). Their mean ( SE) education level was 7 ¼ – (Aust et al., 2013; Kornreich et al., 2013; Naranjo et al., 2011). For 13.1 years ( 2.7, range 9 18). BD was diagnosed by the treating fi example, a study by Punkanen and colleagues (Punkanen et al., clinician and con rmed by a clinically trained psychiatry resident on the basis of the entire Mini International Neuropsychiatric In- 2011) showed that depressed patients’ recognition of emotions terview (MINI, (Sheehan et al., 1998)) and according to the criteria expressed by musical stimuli is biased towards negative emotions of the Diagnostic and Statistical Manual of Mental Disorders, Fourth such as sadness and anger. However, in this study, as in many Edition (DSM-IV (American Psychiatric Association, 1994)). All pa- others, participants were asked to recognize the emotions con- tients scored 16 or under on the Montgomery–Asberg Depression veyed by the music, but not to assess their emotional experience Rating Scale (MADRS) (Montgomery and Asberg, 1979)(M¼5, when listening to the music. In the psychology of emotions and SE¼4.0, range¼0–16), and 11 or under on the Young Mania Rating music psychology, a distinction is made between the recognition of Scale (YMRS) (Young et al., 1978)(M¼3, SE¼3.0, range¼0–11). emotions and the actual experience of emotions (Gabrielson and All the participants with BD were outpatients at the psychiatry Juslin, 2003; Scherer, 2004). The recognition is viewed mainly as a department of the mental health hospital in Rennes, France. As far cognitive process of assigning a label to an emotion expressed by as comorbidities are concerned, according to the MINI, none of the the music. On the other hand, the experience of music-induced patients in the sample exhibited either anxiety or phobic or ad- emotions involves the subjective feeling and also the physiological diction features, although eight patients had tobacco addiction components of emotional reactions. For the present study we (4one pack of cigarettes a day) in addition to their BD. There were choose to ask participants to evaluate the actual experience of no reports of either panic disorder or generalized anxiety disorder. musical emotions, given that in BD the subjective emotional ex- Nineteen patients had bipolar I disorder and six had bipolar II perience is compromised. disorder. Their mean (7SE) age at onset was 34 years (711, We therefore designed a study to test the experience of music- range¼17–59). The mean (7SE) duration of their illness was 14 induced emotions in patients with BD. We chose music to study years (79, range¼2–37). Nine patients had a predominantly ne- patients’ emotional reactivity because this complex auditory and gative polarity, 11 had a predominantly positive polarity, and one affective stimulus is an ecologically sound tool that often forms had neither.
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