Relative left-frontal activity is associated with increased depression in high reassurance-seekers

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Abstract

Excessive reassurance-seeking, which has been associated with depression in many studies, can be defined as the relatively stable tendency to seek assurance perseveratively from others. We hypothesized that although depression has been associated with left-frontal EEG hypoactivity, reassurance-seekers may possess a unique diathesis that is more likely to be associated with increased left-frontal activity. Data were collected from 12 volunteers who were receiving therapeutic services from a University Clinic. EEG asymmetry scores were averaged over two measurement occasions at least 3 weeks apart. As predicted, stable relative right-frontal activity was associated with increased depression in those who were low on reassurance-seeking, while stable relative left-frontal activity was associated with increased depression among high reassurance-seekers. Perhaps those who seek reassurance excessively do so because of their inability to alter their behavior even when environmental cues are no longer reinforcing, which can maintain or exacerbate their depressive symptoms.

Introduction

Depression research has focused on a range of possible diatheses that run the gamut from the biological to the interpersonal. The present study provides a possible avenue toward a rapprochement between two heretofore-separate literatures on interpersonal and biological vulnerabilities namely, excessive reassurance-seeking and asymmetrical frontal lobe activity. Frijda (1986) contends that emotions are outcomes of the process of assessing the world in terms of one’s own goals that, in turn, modify behavioral tendencies. Because of the importance of the frontal lobes for the expression and regulation of both emotional and social behavior, the integration of these separate lines of research provides a possible means for the explanation of previous discrepancies in the literature on frontal asymmetry/depression relations.

With Coyne’s (1976) interactional description of depression as a starting point, Joiner and coworkers have theorized that depression-prone individuals display interpersonal behaviors that increase their vulnerability to future depression (Joiner, 2000, Joiner and Metalsky, 2001). Specifically, these individuals are more likely to engage in excessive reassurance-seeking, or perseverative attempts to elicit feedback from others to assure them that they are cared for and loved. Although this information is affectively pleasing, it conflicts with the individuals’ negative self-views and leads them to doubt the veracity of the information (Swann et al., 1987, Joiner et al., 1993, Joiner and Metalsky, 1995). Consequently, this doubt compels them again to seek reassurance from others and results in a downward interpersonal spiral, including interpersonal rejection (Joiner et al., 1992), ‘contagious depression’ (Joiner, 1994), and exacerbated depression (Joiner and Metalsky, 2001, Joiner et al., 2001).

Accordingly, excessive reassurance-seeking can be defined as the relatively stable tendency to seek assurance persistently from others that one is loved, regardless of how many times these assurances have already been provided (Joiner et al., 1999). Studies have shown reassurance-seeking to be a cohesive, valid, and reliable factor that is relatively specific to depression and relatively distinct from other aspects of interpersonal style (such as general dependency or doubt in others’ sincerity; Joiner and Metalsky, 2001). Multiple studies have demonstrated a reliable association (median value of 0.36) between reassurance-seeking and depression in a variety of samples, including college students, US Air Force cadets, various clinical samples, and women in heterosexual dating relationships (see Joiner et al., 1999; Katz and Joiner, 2001, for a review). At least six studies have demonstrated that excessive reassurance-seeking is a contributory cause to depression (Katz and Joiner, 2001). Studies based on the diathesis-stress model have shown that excessive reassurance-seeking and stress serve as interactive, contributory causes to the later development of depressive symptoms (Joiner and Metalsky, 1995; Katz et al., 1998).

Habitual and excessive reassurance-seeking creates many problems in the interpersonal world of depressed individuals (Pothoff et al., 1995). Because reassurance-seeking initially elicits positive feedback from others, it is not inherently a maladaptive behavior. It is only because some depressed individuals continue to solicit this feedback when it is clearly creating difficulties within their interpersonal relationships that it becomes problematic. It is possible that the negative consequences of excessive reassurance-seeking are secondary in importance to the immediate relief experienced by the depressed individual when he/she receives this reassurance, particularly if the depressed individual is convinced that this behavior is necessary to provide relief. In these situations, the negative consequences may be dismissed altogether (Schmidt et al., 1999). In essence, these persons neglect to regulate their own behavior in response to external social cues that typically guide social interactions (Hamilton and Deemer, 1999). They fail to adapt their behaviors based on environmental contingencies, which may lead to a perseverative questioning of others that ultimately leads to rejection and may maintain their depressive symptoms (Joiner et al., 1999). Biological factors have also been related to an increased vulnerability for the presence and maintenance of depressive symptoms.

Asymmetrical activity in the frontal lobes of the brain has been related to emotional and motivational factors, as well as cognitive and behavioral ones. It has been hypothesized that relative left-frontal activity is related to behavioral approach motivation and positive emotion, whereas the right-frontal region is related to behavioral withdrawal motivation and negative emotion (Davidson, 1995, Davidson et al., 2000). Positive, approach-related emotion, is typically associated with relative left-frontal and anterior-temporal activity, while negative, withdrawal-related emotion has been associated with higher relative activity of the right-frontal and anterior-temporal regions (Ahern and Schwartz, 1985, Davidson, 1995, Harmon-Jones and Allen, 1997, Heller, 1990, Tomarken et al., 1990). However, evidence for these relations is not always consistent (Hagemann et al., 1998, Hagemann et al., 1999).

Several studies have found that depression is associated with less left-frontal activity and/or more right-frontal activity (Bell et al., 1998, Gotlib et al., 1998, Henriques and Davidson, 1991, Roemer et al., 1992). Resting anterior asymmetry has been reported to distinguish depressed from non-depressed individuals during both episodes and remission (Allen et al., 1993, Bell et al., 1998, Henriques and Davidson, 1991), although some evidence for this finding is inconsistent. For example, Reid et al. (1998) largely failed to replicate these previous studies finding decreased left-frontal activity in depressed individuals relative to non-depressed controls across two samples, suggesting the need to identify intervening factors. The asymmetry model may have difficulty accounting for emotions that potentially involve both withdrawal and approach-related strategies, such as anger or sadness. For example, sadness can evoke an approach strategy geared towards retrieving a lost object as well as a withdrawal strategy reflecting the desire to escape from the noxious environment, depending on the context (see Shackman, 2000). As such, there may be factors involved that predict which kinds of strategies individuals may employ.

The frontal lobes of the brain seem to facilitate the ability to navigate a complex social landscape, and are responsible for action selection based on internal and external cues (Kolb and Whishaw, 1995, Kolb and Taylor, 1999). Studies have shown that the frontal cortex plays an important role in the regulation of arousal with respect to behavioral demands (Tucker et al., 1995, Stuss et al., 2000). Because emotions are directly tied into reinforcing and punishing events, a failure to respond to changing environmental cues may lead to inappropriate social and emotional behavior (Rolls et al., 1994). Patients with frontal lobe damage seem to have difficulty using feedback from environmental cues to change or regulate their behavior, such that they are impaired at developing novel strategies to deal with problems (Kolb and Whishaw, 1995). Patients with frontal lobe lesions seem to be unable to alter their behavior based on changes in previously learned associations between environmental stimuli and rewards (Rolls et al., 1994). Perseveration errors, or errors resulting from the failure to modify behavior based on changes in environmental cues, are relatively specific to frontal lobe damage. In addition, research suggests that these types of errors may be more common in patients with right-frontal lobe lesions than those with left-frontal lobe lesions (Haut et al., 1996, Stuss et al., 2000).

Similar to patients with right-frontal lesions, those who seek reassurance excessively may do so because of an inability to alter their behavior even when environmental cues are no longer reinforcing. However, this is not to imply that those high in reassurance-seeking behaviors also evince frontal lobe damage. Rather, the research involving patients with frontal lobe damage serves to implicate a particular area in the cortex that might reflect a tendency towards certain behaviors in ‘normal’ individuals similar in nature, though not as severe, to those with lesions in the area. Specifically, when their reassurance-seeking behaviors fail to provide desired positive feedback, and instead lead to interpersonal rejection, high reassurance-seekers continue to persist in seeking this feedback. This behavior may ultimately lead to rejection of the depressed individual and an increase in depressive symptoms.

Based on research regarding reassurance-seeking and depression, one might expect that reassurance-seeking will moderate the relation between frontal brain asymmetry and depression. Individuals who seek reassurance excessively may behave in a perseverative manner, much like what is seen in patients with right-frontal lesions. This hypothesis is consistent with the motivational model in that proactively seeking feedback from the environment can be considered an ‘approach’ behavior. It is possible that reassurance-seeking represents a unique diathesis for developing depressive symptoms, reflected in frontal brain wave patterns, that is inherently different from the diathesis usually associated with relative left-frontal hypoactivity.

Accordingly, we predicted that reassurance-seeking moderates the relation between depression and frontal asymmetry, such that, in low reassurance-seekers, the usual pattern is found (i.e. relative right-frontal activity is associated with increased depression), but that in high reassurance-seekers, the opposite pattern is found (i.e. relative left-frontal activity is associated with increased depression).

Section snippets

Participants

Data were collected from 12 (six males, six females) right-handed volunteers aged 19–52 (M=32, S.D.=14.47) who were receiving therapeutic services from the Psychology Clinic at Florida State University. Upon application, patients agreed in writing to the research and training nature of the clinic; in addition, they signed a separate and additional informed consent form for this study. Diagnoses were formulated by a trained clinician through a combination of symptom measures and a clinical

Results

Means and standard deviations for each of the dependent measures are as follows. F4-F3 time 1: −0.03 (0.14), F4-F3 time 2: −0.02 (0.20), F8-F7 time 1: −0.09 (0.23), and F8-F7 time 2: −0.19 (0.10). Descriptive statistics for the independent measures are presented in Table 1. BDI and DIRI were not significantly correlated in this sample, although the magnitude and direction of the observed relation in the depressed individuals was comparable to that which has been observed in previous samples (r

Discussion

As was predicted, results showed that reassurance-seeking moderated the relation between depressive symptoms and anterior asymmetry at two anterior sites: mid-frontal and lateral-frontal. This relationship was such that depressive symptoms were related to less left relative to right-frontal activity in low reassurance-seekers, while depression was related to greater left relative to right-anterior activity in high reassurance-seekers. These results suggest that reassurance-seeking and relative

References (46)

  • L Cronbach

    Coefficient alpha and the internal structure of tests

    Psychometrika

    (1951)
  • Davidson, R.J., 1995. Cerebral asymmetry, emotion, and affective style. In: Davidson, R.J., Hugdahl, K. (Eds.), Brain...
  • R.J Davidson et al.

    Emotion, plasticity, context, and regulation: perspectives from affective neuroscience

    Psychological Bulletin

    (2000)
  • J Davila et al.

    Poor interpersonal problem-solving as a mechanism of stress generation in depression among adolescent women

    Journal of Abnormal Psychology

    (1995)
  • Frijda, N.H., 1986. The Emotions. Cambridge, New...
  • I.H Gotlib et al.

    Frontal EEG alpha asymmetry, depression, and cognitive functioning

    Cognition and Emotion

    (1998)
  • D Hagemann et al.

    Frontal brain asymmetry and affective style: a conceptual replication

    Psychophysiology

    (1998)
  • D Hagemann et al.

    The quest for the EEG reference revisited: a glance from brain asymmetry research

    Psychophysiology

    (2001)
  • J.C Hamilton et al.

    Excessive reassurance-seeking as self-regulatory preservation: implications for explaining the relation between depression and illness behavior

    Psychological Inquiry

    (1999)
  • C Hammen

    The generation of stress in the course of unipolar depression

    Journal of Abnormal Psychology

    (1991)
  • E Harmon-Jones et al.

    Behavioral activation sensitivity and resting frontal EEG asymmetry: covariation of putative indicators related to risk for mood disorders

    Journal of Abnormal Psychology

    (1997)
  • Heller, W., 1990. The neuropsychology of emotion: developmental patterns and implications for psychopathology. In:...
  • J.B Henriques et al.

    Regional brain electrical asymmetries discriminate between previously depressed and healthy control subjects

    Journal of Abnormal Psychology

    (1991)
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