Jonathan Rottenberg

Psychological Flexibility as a Fundamental Aspect of Health

Traditionally, positive emotions and thoughts, strengths, and the satisfaction of basic psychological needs for belonging, competence, and autonomy have been seen as the cornerstones of psychological health. Without disputing their importance, these foci fail to capture many of the fluctuating, conflicting forces that are readily apparent when people navigate the environment and social world. In this paper, we review literature to offer evidence for the prominence of psychological flexibility in understanding psychological health. Thus far, the importance of psychological flexibility has been obscured by the isolation and disconnection of research conducted on this topic. Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situational demands; shift mindsets or behavioral repertoires when these strategies compromise personal or social functioning; maintain balance among important life domains; and be aware, open, and committed to behaviors that are congruent with deeply held values. In many forms of psychopathology, these flexibility processes are absent. In hopes of creating a more coherent understanding, we synthesize work in emotion regulation, mindfulness and acceptance, social and personality psychology, and neuropsychology. Basic research findings provide insight into the nature, correlates, and consequences of psychological flexibility and applied research provides details on promising interventions. Throughout, we emphasize dynamic approaches that might capture this fluid construct in the real-world.

Behavioral activation and inhibition systems and the severity and course of depression.

Theorists have proposed that depression is associated with abnormalities in the behavioral activation (BAS) and behavioral inhibition (BIS) systems. In particular, depressed individuals are hypothesized to exhibit deficient BAS and overactive BIS functioning. Self-reported levels of BAS and BIS were examined in 62 depressed participants and 27 nondepressed controls. Clinical functioning was assessed at intake and at 8-month follow-up. Relative to nondepressed controls, depressed participants reported lower BAS levels and higher BIS levels. Within the depressed group, lower BAS levels were associated with greater concurrent depression severity and predicted worse 8-month outcome. Levels of both BIS and BAS showed considerable stability over time and clinical state. Overall, results suggest that BAS dysregulation exacerbates the presentation and course of depressive illness.

Emotion context insensitivity in major depressive disorder

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

Sadness and Amusement Reactivity Differentially Predict Concurrent and Prospective Functioning in Major Depressive Disorder

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

Emotional Reactivity to Daily Events in Major and Minor Depression

Although emotional dysfunction is an important aspect of major depressive disorder (MDD), it has rarely been studied in daily life. Peeters, Nicolson, Berkhof, Delespaul, and deVries (2003) observed a surprising mood-brightening effect when individuals with MDD reported greater reactivity to positive events. To better understand this phenomenon, we conducted a multimethod assessment of emotional reactivity to daily life events, obtaining detailed reports of appraisals and event characteristics using the experience-sampling method and the Day Reconstruction Method (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004) in 35 individuals currently experiencing a major depressive episode, 26 in a minor depressive (mD) episode, and 38 never-depressed healthy controls. Relative to healthy controls, both mood-disordered groups reported greater daily negative affect and lower positive affect and reported events as less pleasant, more unpleasant, and more stressful. Importantly, MDD and mD individuals reported greater reductions in negative affect following positive events, an effect that converged across assessment methods and was not explained by differences in prevailing affect, event appraisals, or medications. Implications of this curious mood-brightening effect are discussed.

Vagal rebound during resolution of tearful crying among depressed and nondepressed individuals

Respiratory sinus arrhythmia (RSA) is an index of the vagal control of heart rate that is associated with emotion regulatory capacity. To examine RSA in depressed and nondepressed participants in the context of an emotion-regulatory challenge, we presented a sad film to induce crying, a behavior associated with heightened parasympathetic activation. We predicted that nondepressed persons who cried would show elevations in RSA during the onset and the resolution of crying. By contrast, we predicted that depressed individuals who cried would fail to exhibit increased RSA over the course of their crying episodes. As hypothesized, nondepressed participants exhibited RSA increases that accompanied the resolution of tearful crying, consistent with a homeostatic function for crying, whereas depressed subjects who cried did not exhibit increased RSA. Results suggest that the physiological self-regulatory mechanisms invoked by crying are compromised in depression.

Major depressive disorder is associated with attenuated cardiovascular reactivity and impaired recovery among those free of cardiovascular disease.

OBJECTIVE To examine cardiovascular reactivity and recovery to laboratory stress among a naturalistic sample of individuals diagnosed with major depressive disorder (MDD) and healthy control participants. Prospective evidence suggests that MDD confers risk for cardiovascular disease equal to or greater than the risk associated with depressed mood. Enhanced cardiovascular reactivity has been proposed as a mechanism explaining increased risk, but data are inconsistent as to whether depressed individuals exhibit enhanced or attenuated reactivity. Further, few studies have examined appraisal and recovery differences. DESIGN Participants diagnosed with MDD (N = 25) and healthy control participants (N = 25) engaged in a cardiovascular reactivity protocol including 2 tasks, each followed by a brief recovery period. MAIN OUTCOME MEASURES Blood pressure, heart rate, pre-ejection period, cardiac output and total peripheral resistance were assessed. Appraisals of tasks were assessed prior to each task. RESULTS Depressed participants exhibited significantly less systolic blood pressure, heart rate, and cardiac output reactivity during speech, less heart rate reactivity during mirror tracing, and less heart rate recovery after speech and mirror tracing than controls. Depressed participants appraised the tasks as more demanding, threatening, and stressful and reported being less able to cope than controls. Appraisals were related to heart rate reactivity, but appraisals did not mediate the relationship between depression group and reactivity. CONCLUSION Impaired recovery rather than exaggerated cardiovascular reactivity may partially explain the increased prospective cardiovascular disease risk in depressed individuals.

Crying threshold and intensity in major depressive disorder

Clinical lore suggests that depression is associated with frequent and intense crying. To test these postulations empirically, a standardized cry-evoking stimulus was presented to depressed and nondepressed participants, and their likelihood of crying and the magnitude of crying-related changes in their emotion experience, behavior, and autonomic physiology were compared. Unexpectedly, crying was no more likely in depressed than in nondepressed participants. Within the nondepressed group, participants who cried exhibited increases in the report and display of sadness and had greater cardiac and electrodermal activation than did participants who did not cry. There was less evidence of this crying-related emotional activation within the depressed group. The lack of emotional activation among clinically depressed participants who cried provides a tantalizing clue concerning how emotions are dysregulated in this disorder.

Respiratory sinus arrhythmia as a predictor of outcome in major depressive disorder

BACKGROUND Respiratory sinus arrhythmia (RSA) is a noninvasive measure of parasympathetic tone that has been related to emotion regulatory capacity. While some previous work indicates that clinically depressed persons exhibit lower levels of RSA than do normal controls, there is nevertheless considerable between-subject variation in RSA among depressed persons. The current study evaluated the significance of variation in RSA among depressed persons by examining whether levels of RSA predicted concurrent symptomatology and the course of depressive illness. METHODS The RSA levels of 55 diagnosed depressed individuals were assessed during a paced breathing procedure at Time 1. Six months later (Time 2), participants were interviewed again to determine whether or not each had fully recovered from depression. Multinomial regression analyses were conducted to examine whether RSA predicted Time 2 clinical status. RESULTS Although RSA levels were not related to overall depression severity, they were associated with specific symptoms of depression: RSA was positively associated with the report of sadness and negatively associated with the report of suicidality. More strikingly, however, higher levels of RSA at Time 1 predicted non-recovery from depression at Time 2, even when statistically controlling for initial depression severity, age and medication use. LIMITATIONS Treatment and medication use were not controlled during the follow-up period and a group of nonpsychiatric controls was not included in this study. CONCLUSIONS A relatively high level of RSA among depressed individuals predicts a more pernicious course of illness than do lower RSA levels.

Poor reported sleep quality predicts low positive affect in daily life among healthy and mood-disordered persons.

Sleep disturbance is a core symptom of mood disorders. However, surprisingly little is known about the relationship between sleep quality and ambulatory daily mood, especially in mood‐disordered populations. We assessed ambulatory positive affect (PA) and negative affect (NA) 10 times daily for three consecutive days with the computerized experience sampling method among persons with major depression (n = 35), minor depression (n = 25) and healthy controls (n = 36). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Poorer sleep quality predicted lower ambulatory PA, even after accounting for the effects of diagnostic group and self‐reported anxiety. Conversely, sleep quality did not predict ambulatory NA once diagnostic group was accounted for. Analyzes of specific PSQI component scores indicated that poor subjective sleep quality and self‐reported daytime dysfunction were the sleep components most strongly tied to reports of low ambulatory PA. Impaired sleep quality may be responsible for reduced pleasurable experience in everyday life.