Mood and Emotion in Major Depression Jonathan Rottenberg

CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE

University of South Florida

ABSTRACT—Nothing is more familiar to people than their DOES DEPRESSED MOOD FACILITATE SAD moods and emotions. Oddly, however, it is not clear how EMOTIONAL REACTIONS? these two kinds of affective processes are related. Intui- tively, it makes sense that emotional reactions are stronger One approach to studying mood–emotion interaction is to ex- when they are congruent with a preexisting mood, an idea amine mood-disturbed individuals. People who suffer from major reinforced by contemporary emotion theory. Yet empiri- depressive disorder, commonly known as major depression, have cally, it is uncertain whether moods actually facilitate a markedly severe type of mood disturbance. Major depression is emotional reactivity to mood-congruent stimuli. One ap- the leading cause of psychiatric hospitalization; it is estimated proach to the question of how moods affect emotions is to to affect nearly one out of seven people and is associated with study mood-disturbed individuals. This review describes several adverse consequences, including increased risk of sui- recent experimental studies of emotional reactivity con- cide. Major depression is defined as a 2-week period of persistent ducted with individuals suffering from major depression. sad mood and/or a loss of interest or pleasure in daily activities, Counter to intuitions, major depression is associated with as well as four or more additional symptoms, such as marked reduced emotional reactivity to sad contexts. A novel ac- changes in weight or appetite, sleep disturbance, pervasive guilt, count of emotions in depression is advanced to assimilate fatigue, and difficulty concentrating. Although major depression these findings. Implications for the study of depression and is a complex package of symptoms, a profound change in mood is normal mood variation are considered. its most characteristic feature. Major depression thus provides a rich context for exploring the ways that mood alters emotional KEYWORDS—depression; emotion; mood; affect; reactivity reactivity. In considering mood–emotion interaction in depression, the Isn’t it a common experience that moods make people more first problem arises from the very slipperiness of the core terms, emotionally volatile? For example, don’t irritable moods make it mood and emotion. Indeed, some researchers, clinicians, and easier for even a minor slight to trigger outbursts of rage? Don’t laypeople have used these terms in confusing and incommen- anxious moods make people so jumpy that a few strange noises in surate ways. For clarity and to follow current practices in affec- thenightwill provoke full panicandterror? This article considers tive science (Watson, 2000; Rottenberg & Gross, 2003), I here the interplay of moods and emotions, by focusing on studies that use moods to mean diffuse, slow-moving feeling states that are examine one mood (depressed mood) and one emotion (sadness) weakly tied to specific objects or situations. By contrast, emo- in one population (clinically depressed persons). I first consider tions are quick-moving reactions that occur when organisms the intuitive hypothesis that major depression facilitates sad encounter meaningful stimuli that call for adaptive responses. emotional reactions. Second, I describe a series of experiments Emotional reactions typically involve coordinated changes in that yielded results largely inconsistent with this idea. Third, I feeling state, behavior, and physiology, and last seconds or assimilate these novel findings into an alternative framework for minutes. Moods, by contrast, exert their clearest effects on understanding emotions in major depression. Finally, I highlight feeling states and cognitions (as opposed to behavior and phys- three directions for future research on the interaction between iology) and last hours or days. When mood and emotion are dis- mood and emotion. tinguished in this way, it becomes apparent that depression, by definition, involves changes in moods but does not necessarily involve changes in emotional reactions. Address correspondence to Jonathan Rottenberg, Department of Psychology, University of South Florida, 4202 E. Fowler Ave., PCD Emotion theorists have posited that moods facilitate emotional 4118G, Tampa, FL 33620-7200; e-mail: [email protected]. reactions when the mood and the emotion are similar in nature

Volume 14—Number 3 Copyright r 2005 American Psychological Society 167 Mood and Emotion in Major Depression

(e.g., Rosenberg, 1998). Does depressed mood facilitate sad persons’sadness already being at an upper limit of measure while emotional reactions? Circumstantial evidence suggests it does. watching the neutral film. The difference remained significant From early psychoanalytic formulations of depression to con- even after depressed participants who had reported very high temporary cognitive conceptualizations, depression scholars levels of sadness to the neutral film were removed from the have noted an increased expression of negative thoughts and analysis. feelingsinthisdisorder.Depressed persons’increased reportand display of negative feelings is apparent in several settings. For Further Violations of the Mood-Facilitation Hypothesis in example, depressed persons typically report (in interviews and Depression on questionnaires) strong sadness behaviors such as crying Although a single violation of the mood-facilitation hypothesis is spells. These self-reports of increased tearfulness are corrobo- not decisive in itself, the lack of any support for the hypothesis in ratedbytheobservationsofmentalhealthprofessionals,whonote our first analysis gave us pause. Wereour results an anomaly? To that depressed persons are prone to cry in therapeutic settings. find out, we sought to test the mood-facilitation hypothesis under Although these clinical observations are consistent with the conditions that we expected to favor its confirmation. mood-facilitation hypothesis, they do not in themselves establish that depressed persons react more strongly than other people to Crying Responses sad stimuli. For example, observations of notable crying in One alternative explanation for why depressed individuals clinical contexts could reflect changes in depressed persons’ originally reported relatively little change in their feeling state in social behavior, such as a tendency to seek comfort from poten- response to our sad film is that the film simply failed to engage the tially sympathetic others (Coyne, 1976). Likewise, increased depressed participants. It is easy to imagine, for example, that the crying could reflect that depressed persons are exposed to more concentration difficulties experienced by depressed persons, or sad stimuli in their everyday environments than are healthy in- their lack of motivation to watch films, could curtail the impact of dividuals. Indeed, depressed persons are almost certainly faced a sad film. To address the possibility that our results were a with a different world of emotion-generative stimuli than healthy consequence of low engagement, we reanalyzed our data, fo- individuals are. For these reasons, a better way to test the mood- cusing only on those depressed and healthy participants who facilitation hypothesis is to assess depressed and healthy indi- responded to the sad film with verifiable crying behavior (visible viduals’ emotional reactivity to controlled sadness-eliciting tears in the eyes); we assumed that participants who visibly cried stimuli in the laboratory. during the film were fully engaged with it. Indeed, given the popular belief that depressed persons cry readily and intensely,it Testing the Mood-Facilitation Hypothesis seemed reasonable to expect that these analyses of criers would To test the mood-facilitation hypothesis, my colleagues and I favor the facilitation hypothesis. created short films, using material taken from commercially Despite this expectation, when criers in the two diagnostic available movies; our films were designed to elicit specific groups were compared directly, depressed criers did not exhibit a emotional states, and we pretested them in healthy populations. greater response to the sad film in their emotional experience, Of particular interest were responses to films that were edited expressive behavior (e.g., tearful eyes, furrowed brow, down- either to elicit sadness or a neutral state (i.e., few reports or turned mouth), or physiological responses such as heart rate and displays of emotion in healthy participants; Rottenberg, Kasch, skin conductance (a measure of sweat gland activity). In fact, as Gross, & Gotlib, 2002). The sad film dramatized a death scene displayed in Figure 1, when reactivity was computed from a and revolved around themes of loss and grief; the neutral film neutral reference, depressed criers actually showed smaller depicted relatively innocuous landscape scenery. We recorded changes in their emotional experience and physiology than depressed and nondepressed participants’ self-reported emo- healthy criers did (Rottenberg, Gross, Wilhelm, Najmi, & Gotlib, tional experience and their observed expressive behavioral re- 2002). Therefore, restriction of the analysis to criers did not yield actions and physiological reactions to the films. Surprisingly, the support for the mood-facilitation hypothesis. In fact, our results results from this study did not support the mood-facilitation hy- suggested that depression might actually blunt the distress and pothesis. First, depressed individuals’ experiential, behavioral, arousal that is typically associated with crying (Gross, Frede- and physiological reactions to the sad film were of similar mag- rickson, & Levenson, 1994). nitude to those of healthy people. Second, depressed participants reported greater sadness than healthy participants in response to Personally Tailored Sad Stimuli the neutral film. Third, and most strikingly, when responses to the Analysis of criers suggested that depressed persons’ reduced neutral film were used as a reference point, a typical practice in response to sad material was unlikely to be an artifact of low studies of emotional reactivity, depressed subjects actually re- engagement. Still, the possibility remained that our sad film was ported smaller increases insad feelings inresponse tothesad film not an ideal stimulus for eliciting sadness in a depressed indi- than healthy controls did. Finally, this group difference did not vidual, in part because it was not relevant to the concerns of appear to be a ceiling effect—that is, a consequence of depressed someone suffering from a serious disorder such as major de-

168 Volume 14—Number 3 Jonathan Rottenberg

Rethinking Emotional Functioning in Depression Healthy Criers It has long been known that depressed individuals exhibit rela- Depressed Criers tively little reactivity to positive emotional contexts (e.g., less 6 6 smiling at jokes). The data presented here are novel in suggesting 5 5 that this lack of reactivity extends to negative emotional contexts. To be clear, in these studies, depressed persons do respond to sad 4 4 stimuli with reports of sadness and behavioral signs of sadness. 3 3 But, remarkably,they appear to show essentiallythe same pattern Self-reported sadness

∆ 2 2 of response to sad stimuli as they do to emotionally innocuous Skin conductance responses

∆ stimuli. In other words, depression flattens the emotional land- 1 1 scape, greatly constricting the range of emotional reactions to differing emotional contexts. My colleagues and I label this Fig. 1. Differences in self-reported sadness (left) and skin-conductance emotionally constricted pattern emotion context insensitivity response rate (right) between healthy and depressed individuals who cried (ECI; Rottenberg et al., 2004). in response to a sad film. Adapted from ‘‘Crying threshold and intensity in major depressive disorder,’’ by J. Rottenberg, J.J. Gross, F.H. Wilhelm, S. Najmi, and I.H. Gotlib, 2002, Journal of Abnormal Psychology, 111, Converging Evidence for ECI in Major Depression p. 307. Copyright 2002 by the American Psychological Association. Adapted with permission. ECI—though a novel label—accords with several previous observations of depression. First, ECI accords with naturalistic observations of depressed persons’ behavior. Depressed patients pression. After all, the sad film had been drawn from a com- often exhibit few changes in expressive behavior to environ- mercial entertainment, and it dramatized the misfortunes of other mental events and display monotonous sad expressions. Second, people using a fairly generic theme of loss. Would the mood- ECI accords with depressed patients’ personal descriptions of facilitation hypothesis hold if a more personally relevant sad their disorder, which often feature emotional constriction: Pa- stimulus were employed? tients describe their world as being flat, dull, and empty, and they Toanswer thisquestion, werepeatedourexperimentwithanew remark that ‘‘everything is the same’’ (Healy, 1993). Third, ECI sample of participants (again, depressed people and a healthy accords with the findings of recent investigations of emotion in control group). This time, we included personally tailored emo- major depression. For example, a recent naturalistic study found tional films alongside the standardized emotional films previ- that, relative to healthy persons, depressed persons reported less ously used. The personally tailored films, drawn from videotaped emotional sensitivity to negative events (Peeters, Nicolson, Be- interviews, were videotapes of the participants themselves rkhof, Delespaul, & deVries, 2003). talking about the saddest and happiest events from their own lives. (Segments of videotape of participants answering demo- graphic questions about themselves were used as a neutral ref- The Clinical Significance of ECI erence.) Remarkably, results indicated that even when they were What are the clinical implications of ECI? Although ECI is a responding to emotional films depicting themselves relating sad generally observable feature in depressed patients, patients also events that had happened to them personally, depressed persons varyintheextenttowhichtheyshowECI.Earlydatasuggeststhat still did not show greater sensitivity to sad stimuli than healthy depressed patients with the most pronounced ECI may face a controls did. The results instead confirmed our earlier result: relatively worse prognosis. For example, we found that those Depressed individuals reported considerable sadness to neutral depressed persons who reported the most similar reactions to sad emotional material and reported little differential response to and neutral contexts (the constricted pattern expected by ECI) acutely sad material (Rottenberg, Gross, & Gotlib, 2004). evidenced the most impaired functioning—specifically, the most severe depression, the longest episodes of depression, and the IMPLICATIONS OF THESE FINDINGS poorest overall psychosocial functioning (Rottenberg, Kasch, et al., 2002). Also underscoring the potential clinical importance In summary, none of our work conducted with individuals with of ECI, we recently found that depressed individuals who dis- major depression has adduced evidence for the mood-facilitation closed the least sad emotionwhendiscussing memoriesof sad life hypothesis. In fact, our data indicate that major depression ac- events showed the least improvement of their symptoms 1 year tually impedes reactivity to sad stimuli. Thus, contrary to both later (Rottenberg, Joormann, Brozovich, & Gotlib, in press). common intuition and emotion theory (Rosenberg, 1998), strong moods may not always facilitate strong emotional reactions to a Does Depressed Mood Have a Purpose? mood-relevant stimulus. These findings have implications for Depressed mood is painful, is associated with terrible human how we understand major depression and the broader relation- costs, and is remarkably prevalent. Scholars and sufferers alike ship between mood and emotion. have wondered whether depressed mood has any purpose. That

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severe depressed-mood states impede emotional reactions may stimuli designed to elicit sadness is generalizable, other negative speak to the possible functions of depressed mood. Nesse (2000) emotions (e.g., anger) should be examined with equal care. postulated that depressed mood evolved originally as an internal How does mood inﬂuence other aspects of emotion besides the signaldesigned to biasanorganism against action,particularlyin magnitude of emotional responses? Affective science is in- adverse situations in which continued activity might prove to be creasingly highlighting the payoffs of studying the timing and futile or dangerous (e.g., famine). Depressed mood may drive orchestration of emotion, for instance the speed at which emo- severalfeaturesassociatedwithdepression—such aspessimism, tional responses rise and fall (e.g., Rottenberg & Gross, 2003). self-absorption, and loss of interest in the environment—that Thus, future work on mood–emotion interaction should study not hold a person in place and prevent ill-considered actions. In this only mood’s effects on emotion magnitude but on these other way, severe depressed-mood states may constitute a broad de- aspects of the unfolding emotion waveform. fensive response that ‘‘shuts down’’ motivated activity.

Recommended Reading When Might Mood Facilitation Hold? Nesse, R.M. (2000). (See References) Strong moods may not always facilitate emotional reactions to Rottenberg, J., Gross, J.J., Wilhelm, F.H., Najmi, S., & Gotlib, I.H. mood-relevant stimuli, but how general is the exception? Should (2002). (See References) the intuition that irritable moods predispose people to angry Rottenberg, J., Kasch, K.L., Gross, J.J., & Gotlib, I.H. (2002). (See outbursts and tense moods to anxiety attacks be abandoned? References) Although more compelling empirical demonstration of mood facilitation is needed, considerable indirect evidence for mood facilitation does exist, particularly for anxiety. In fact, most REFERENCES characterizations of anxiety disorders refer to prevailing anxious Barlow, D. (2002). Anxiety and its disorders. New York: Guilford Press. mood and to strong emotional reactions to mood-relevant stimuli Beach, S.R.H., & Amir, N. (2003). Is depression taxonic, dimensional, (e.g., panic attacks, phobic reactions; see Barlow, 2002). Clinical or both? Journal of Abnormal Psychology, 112, 228–236. anxiety and depression often co-occur; if it can be shown that Coyne, J.C. (1976). Toward an interactional description of depression. anxious and depressed moods affect emotion differently, this fact Psychiatry, 39, 28–40. may help better distinguish the two conditions (Watson, 2000). Gross, J.J., Frederickson, B.L., & Levenson, R.W. (1994). The psychophysiology of crying. Psychophysiology, 31, 460–468. Healy, D. (1993). Dysphoria. In C.G. Costello (ed.) Symptoms of De- FUTURE DIRECTIONS pression (pp. 23–42). New York: John Wiley. Larsen, R.J., & Ketelaar, T. (1991). Personality and susceptibility to This review suggests that studying emotional disorders such as positive and negative emotional states. Journal of Personality and major depression can yield surprising insights about the interac- Social Psychology, 61, 132–140. tions of mood and emotion. As we learn more about mood–emotion Nesse, R.M. (2000). Is depression an adaptation? Archives of General interaction, surely other surprising ﬁndings will follow. I close by Psychiatry, 57, 14–20. Peeters, F., Nicolson, N.A., Berkhof, J., Delespaul, P., & deVries, M. highlighting three important questions for future research. (2003). Effects of daily events on mood states in Major Depressive Do mild depressed moods affect emotion differently than Disorder. Journal of Abnormal Psychology, 112, 203–211. clinical depression does? Careful assessment of emotional re- Rosenberg, E.L. (1998). Levels of analysis and the organization of affect. activity across the range of depressed mood may reveal that mild Review of General Psychology, 2, 247–270. depression facilitates emotional reactions, whereas clinical de- Rottenberg, J., Gross, J.J., & Gotlib, I.H. (2004). Emotion context insen- pression impedes them. Such nonlinearity would further enrich sitivity in major depression. Manuscript submitted for publication. the debate about whether depression is best conceived as a Rottenberg, J., Gross, J.J., Wilhelm, F.H., Najmi, S., & Gotlib, I.H. (2002). Crying threshold and intensity in major depressive disor- continuum or a discrete category (Beach & Amir, 2003). Such der. Journal of Abnormal Psychology, 111, 302–312. nonlinearity would also raise intriguing questions about research Rottenberg, J., Joormann, J., Brozovich, F., & Gotlib, I.H. (in press). on neuroticism (a personality trait, involving unstable affect, that Emotional intensity of idiographic sad memories in depression is a risk factor for depression), which has demonstrated that predicts symptom levels one year later. Emotion. neurotic individuals react more strongly than non-neurotic in- Rottenberg, J., Kasch, K.L., Gross, J.J., & Gotlib, I.H. (2002). Sadness dividuals to negative stimuli (Larsen & Ketalaar, 1991). and amusement reactivity differentially predict concurrent and How do the consequences of depressed moods differ from that prospective functioning in major depressive disorder. Emotion, 2, 135–146. of other moods? Parallel investigations using other mood states Rottenberg, J., & Gross, J.J. (2003). When emotion goes wrong: Real- (e.g., irritable, anxious, and positive) will be critical for exam- izing the promise of affective science. Clinical Psychology: Science ining the boundary conditions for mood facilitation. Likewise, to and Practice, 10, 227–232. determine whether depressed persons’ diminished response to Watson, D. (2000). Mood and temperament. New York: Guilford Press.

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