When negative interpretations persist, positive emotions don't! Inflexible negative interpretations encourage depression and social anxiety by dampening positive emotions
Introduction
The identification of mechanisms involved in depression and social anxiety is an integral part of efforts to improve existing prevention and treatment strategies for these burdensome disorders (Kessler & Bromet, 2013; Stein & Stein, 2008). Theoretical models advocate that individual differences in emotion regulation are important determinants of the emotional disturbances that characterize depression and anxiety (Hofmann, Sawyer, Fang, & Asnaani, 2012; Joormann, 2010; Morrison & Heimberg, 2013). Emotion regulation refers to a range of automatic and strategic processes that influence the frequency, intensity, and duration of emotional experiences (Gross, 2014). A plethora of studies have tied depression and (social) anxiety to the use of specific emotion regulation strategies in response to both negative and positive emotions (Campbell-Sills, Ellard, & Barlow, 2014; Dryman & Heimberg, 2018; Joormann & Stanton, 2016; Liu & Thompson, 2017).
In response to negative emotions or distress, depressed and anxious individuals habitually engage in repetitive negative thinking and use positive reappraisal less frequently (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Kivity & Huppert, 2018; Visted, Vøllestad, Nielsen, & Schanche, 2018). Repetitive negative thinking refers to a transdiagnostic process of persistent thinking about negative topics (e.g., past distress, future threats) that is difficult to control (Ehring et al., 2011; Mahoney, McEvoy, & Moulds, 2012; Watkins, 2008). Repetitive negative thinking is related to exacerbated negative mood (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008), heightened emotional reactivity (Ruscio, Seitchik, Gentes, Jones, & Hallion, 2011), and impaired stress recovery (Watkins, 2008). Positive reappraisal has been defined as cognitively reframing the meaning of a distressing event in a more positive manner to minimize its emotional impact (Garnefski & Kraaij, 2007; Gross, 2014). Decreased use of positive reappraisal may prevent depressed and anxious individuals from obtaining beneficial outcomes associated with this strategy, such as increased positive and decreased negative emotions (Gross & John, 2003) and better stress recovery (Jamieson, Nock, & Mendes, 2012).
In response to positive emotions, depressed and anxious individuals are more likely than control individuals to dampen their emotional experiences (Eisner, Johnson, & Carver, 2009; Feldman, Joormann, & Johnson, 2008; Raes, Smets, Nelis, & Schoofs, 2012; Werner-Seidler, Banks, Dunn, & Moulds, 2013). Dampening involves a repetitive style of thought (e.g., “my streak of luck is going to end soon”, “good things won't last”) that serves to reduce the intensity and duration of positive emotions (Feldman et al., 2008). The tendency to respond to positive emotions with dampening predicts future depressive symptom levels (Raes et al., 2012) and is uniquely related to anxiety and depression symptoms when controlling for repetitive negative thinking (McEvoy et al., 2018). Considered together, these studies provide accumulating evidence that patterns of emotion regulation strategy use may contribute to emotion dysregulation in individuals with depression and anxiety.
Despite this scientific progress, the mechanisms that give rise to this maladaptive pattern of emotion regulation strategy use remain underspecified. Cognitive theories of depression and anxiety posit that biases in interpreting ambiguous emotional situations are important determinants of the emotional disturbances observed in these internalizing disorders (Everaert, Podina, & Koster, 2017b; Hirsch, Meeten, Krahé, & Reeder, 2016). Research indicates that depressed individuals develop more negative and fewer positive interpretations to explain ambiguous information (Everaert, Grahek, et al., 2017a). Furthermore, studies have shown that socially anxious individuals report fewer positive interpretations at the time when ambiguity is first encountered and report more negative interpretations when elaborating on ambiguous information (Amir, Prouvost, & Kuckertz, 2012; Beard & Amir, 2009; Hirsch et al., 2016; Moser, Hajcak, Huppert, Foa, & Simons, 2008). Importantly, biased interpretation of ambiguity has been linked to the decreased use of positive reappraisal (Everaert, Grahek, et al., 2017a) and increased engagement in repetitive negative thinking (Badra et al., 2017; Everaert, Grahek, et al., 2017a; Mor, Hertel, Ngo, Shachar, & Redak, 2014; Wisco, Gilbert, & Marroquin, 2014).
Notwithstanding the putative pathogenic role of interpretation bias, investigators are increasingly emphasizing that bias toward negative or positive interpretations may not be consistently (mal)adaptive. For example, even biased negative interpretations may motivate people to adjust their behavior to meet situational demands. Consistently drawing positive interpretations may lead people to ignore important negative features of situations, such as problems at work or difficulties in romantic relationships. Whether negative or positive interpretations promote (mal)adaptive behavior hinges on the fluctuating demands of the context in which these interpretations are made (Everaert, Bronstein, Cannon, & Joormann, 2018; Kashdan & Rottenberg, 2010; Mehu & Scherer, 2015; Stange, Alloy, & Fresco, 2017). Recent models propose that the inflexibility with which negative interpretations are formed and maintained may determine the misfit between interpretations and changing situational demands, thereby dysregulating negative emotions and encouraging maladaptive emotion regulation strategies in psychopathology (Mehu & Scherer, 2015).
Interpretation inflexibility refers to the impaired integration of initial understandings of a situation with information that subsequently becomes available. Interpretation inflexibility therefore hampers the revision of initial interpretations in the face of disconfirmatory evidence (Bronstein & Cannon, 2018). Recent empirical work suggests that the interpretation of unfolding situations in depression and social anxiety is marked by inflexibility (Everaert et al., 2018). In that study, an emotional variant of the Bias Against Disconfirmatory Evidence (BADE) task was developed to disentangle interpretation bias and inflexibility. The results demonstrated that both depression and social anxiety symptoms were related to reduced revision of negative interpretations in the face of disconfirmatory positive information (even when their associations with interpretation bias were considered). Indeed, it seems plausible that inflexibility in revising negative interpretations may maintain negative emotions in evolving situations that might otherwise evoke experiences (e.g., of positive emotion) that relieve internalizing symptoms (Mehu & Scherer, 2015). This context-insensitive elicitation of negative emotions and interpretations may determine the (in)sensitivity of emotion regulation strategy implementation to changing contexts. Accordingly, the inflexibility with which negative interpretations are formed and maintained in the face of disconfirmatory positive information may facilitate engagement in repetitive negative thinking and dampening, but may interfere with the use of positive reappraisal.
Despite the intuitive appeal of the inflexibility account, research has not yet examined whether inflexible negative interpretations of ambiguous information are associated with emotion regulation difficulties that have been previously linked to depression and anxiety. This investigation focused on depression and social anxiety because of the high comorbidity between these disorders (Adams, Balbuena, Meng, & Asmundson, 2016), their overlapping emotional information-processing biases (Everaert, Grahek, et al., 2017a; Hirsch et al., 2016; Morrison & Heimberg, 2013), and the social nature of the stimuli presented in the belief revision task used in the present studies.
The present studies employed a recently developed task that requires the revision of emotion-laden interpretations of scenarios that prominently feature social concerns (Everaert et al., 2018). Using this task, the present studies examined the relation between inflexibility in negative interpretations and the use of widely investigated emotion regulation strategies that have been previously associated with depression and social anxiety. In particular, this study focused on repetitive negative thinking, positive reappraisal, and dampening of positive emotions. In accordance with psychological (in)flexibility perspectives on psychopathology (e.g., Mehu & Scherer, 2015; Stange et al., 2017), it was hypothesized that negative interpretation inflexibility would be related to more frequent use of repetitive negative thinking and dampening as well as less frequent use of positive reappraisal (Hypothesis 1). Furthermore, as predicted by cognitive models of emotion (dys)regulation (Hofmann et al., 2012; Joormann, 2010; Mehu & Scherer, 2015), it was expected that the use of emotion regulation strategies would mediate the relation between cognitive factors (here: negative interpretation inflexibility) and symptoms of depression and social anxiety (Hypothesis 2). Lastly, the present studies also attempted to replicate previous findings regarding the relation between negative interpretation inflexibility and symptoms of depression and social anxiety. In line with prior work (Everaert et al., 2018), it was hypothesized that greater inflexibility in revising negative interpretations would be associated with more severe depression and social anxiety symptoms (Hypothesis 3).
Testing these hypotheses using the recently developed emotional BADE task (Everaert et al., 2018) allowed this study to disentangle biased and inflexible emotional interpretations with respect to their relations with internalizing symptoms and emotion regulation strategy use. In light of prior research, it was expected that interpretation biases would be related to emotion regulation strategy use (Badra et al., 2017; Everaert, Grahek, et al., 2017a; Mor et al., 2014; Wisco et al., 2014) as well as symptoms of depression and social anxiety (Everaert et al., 2018; Everaert, Grahek, et al., 2017a; Hirsch et al., 2016).2 By examining these hypotheses, the present study was expected to shed light on the cognitive mechanisms that may give rise to maladaptive profiles of emotion regulation strategy use in individuals with psychopathology.
Section snippets
Participants and sampling strategy
Participants were recruited via Amazon's Mechanical Turk (MTurk). MTurk provides an online crowdsourcing platform with access to large and diverse samples that are suitable for clinical research collecting mental health data (Chandler & Shapiro, 2016). Participation in this study was restricted to MTurk users who were 18 years or older and living in the United States.
In keeping with the Research Domain Criteria (Insel et al., 2010), this study employed a dimensional approach that considered
Descriptive statistics and correlational analysis
Correlations among depressive symptoms (BDI-II), social anxiety levels (LSAS anxiety), and emotion regulation strategies are presented in Supplement 4. As a result of the stratified sampling approach, participants' BDI-II scores represented almost the full spectrum of symptom severity (M = 15.63, SD = 12.58): 123 respondents reported minimal (range: 0–13), 40 reported mild (range: 14–19), 44 reported moderate (range: 20–28), and 42 reported severe (range: 29–54) symptoms. The BDI-II data of one
Participants and sampling strategy
This replication study was part of a larger project that also examined analytic reasoning and interpretation flexibility in relation to paranoid ideation (Bronstein, Everaert, Castro, Joormann, & Cannon, 2019). A sample of 294 individuals was recruited via Amazon's Mechanical Turk (MTurk). Only individuals who were 18 years or older, lived in the United States, and had a history of providing good-quality responses (i.e., an acceptance ratio of ≥96%) were allowed to participate.
Participants were
Descriptive statistics and correlational analysis
Participants' BDI-II scores covered almost the full range of depressive symptom severity (M = 13.05, SD = 12.65): 167 respondents reported minimal (range: 0–13), 40 reported mild (range: 14–19), 47 reported moderate (range: 20–28), and 40 reported severe (range: 29–52) symptoms. Significant variation was also found in participants’ scores on the anxiety subscale of the LSAS (M = 24.15, SD = 17.59, range: 0–66). Regarding the total scores on the LSAS, 112 respondents reported levels at which
General discussion
The present investigation examined whether inflexible negative interpretations of ambiguous information may promote the maladaptive use of emotion regulation strategies that have been previously related to symptoms of depression and anxiety. Two studies demonstrated that inflexibility of negative interpretations is reliably and uniquely associated with the dampening of positive emotions. In line with Hypothesis 2, this finding suggests that individuals with difficulties adjusting negative
Data statement
Anonymized data were made available for the anonymous reviewers and are publicly available via the Open Science Framework (osf.io/k95ds).
Declaration of competing interest
The authors declare no conflict of interest.
This work was supported by postdoctoral research grants from the Belgian American Educational Foundation (B.A.E.F.; Cabeaux-Jacobs Fellow), Special Research Fund (BOF) of Ghent University, and the Research Foundation – Flanders (FWO-Vlaanderen; 1202119N) awarded to Jonas Everaert.
References (69)
- et al.
When social anxiety and depression go together: A population study of comorbidity and associated consequences
Journal of Affective Disorders
(2016) - et al.
Emotion-regulation strategies across psychopathology: A meta-analytic review
Clinical Psychology Review
(2010) - et al.
Measuring bias against disconfirmatory evidence: An evaluation of BADE task scoring methods and the case for a novel method
Psychiatry Research
(2018) - et al.
Pathways to paranoia: Analytic thinking and belief flexibility
Behaviour Research and Therapy
(2019) - et al.
Emotion regulation in social anxiety and depression: A systematic review of expressive suppression and cognitive reappraisal
Clinical Psychology Review
(2018) - et al.
The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking
Journal of Behavior Therapy and Experimental Psychiatry
(2011) - et al.
Positive affect regulation in anxiety disorders
Journal of Anxiety Disorders
(2009) - et al.
A comprehensive meta-analysis of interpretation biases in depression
Clinical Psychology Review
(2017) - et al.
Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples
Personality and Individual Differences
(2006) - et al.
Negative life events, cognitive emotion regulation and emotional problems
Personality and Individual Differences
(2001)
Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation
Behaviour Research and Therapy
The cognitive emotion regulation questionnaire: Factorial, convergent, and criterion validity analyses of the full and short versions
Personality and Individual Differences
Examining emotion regulation in depression: A review and future directions
Behaviour Research and Therapy
Psychological flexibility as a fundamental aspect of health
Clinical Psychology Review
Psychometric properties of the repetitive thinking questionnaire in a clinical sample
Journal of Anxiety Disorders
Transdiagnostic assessment of repetitive negative thinking and responses to positive affect: Structure and predictive utility for depression, anxiety, and mania symptoms
Journal of Affective Disorders
Interpretation bias characterizes trait rumination
Journal of Behavior Therapy and Experimental Psychiatry
A cognitive-behavioral model of anxiety in social phobia
Behaviour Research and Therapy
Perseverative thought: A robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder
Behaviour Research and Therapy
Social anxiety disorder
The Lancet
An investigation of the relationship between positive affect regulation and depression
Behaviour Research and Therapy
Lack of a benign interpretation bias in social anxiety disorder
Cognitive Behaviour Therapy
The association between ruminative thinking and negative interpretation bias in social anxiety
Cognition & Emotion
Interpretation in social anxiety: Whenmeaning precedes ambiguity
Cognitive Therapy and Research
An inventory for measuring clinical anxiety: Psychometric properties
Journal of Consulting and Clinical Psychology
Manual for the Beck depression inventory-II
Bias against disconfirmatory evidence in a large nonclinical sample: Associations with schizotypy and delusional beliefs
Journal of Experimental Psychopathology
Emotion regulation in anxiety disorders
Conducting clinical research using crowdsourced convenience samples
Annual Review of Clinical Psychology
Scientific foundations of cognitive theory and therapy of depression
A psychometric evaluation of the Beck depression inventory-II
Psychological Assessment
Looking through tinted glasses: Depression and social anxiety are related to both interpretation biases and inflexible negative interpretations
Clinical Psychological Science
Mapping the interplay among cognitive biases, emotion regulation, and depressive symptoms
Cognition & Emotion
Responses to positive affect: A self-report measure of rumination and dampening
Cognitive Therapy and Research
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These authors contributed equally to this work.