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Enhanced Anger Reactivity and Reduced Distress Tolerance in Major Depressive Disorder

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Abstract

Difficulty with effective emotion regulation is a central feature of major depressive disorder (MDD). Correlational evidence suggests that people with MDD experience elevated levels of irritability and anger, although few studies have experimentally tested this idea. The current study examined emotional reactivity across self-report (anger ratings), behavioral (task persistence), and physiological (heart rate, skin conductance) domains in response to a standardized, frustrating task in young adults with MDD (n = 74) and without MDD (n = 107). A secondary goal was to determine whether regulating emotional response with reappraisal, acceptance, or no instruction mitigated emotional reactivity across these domains. People with MDD responded with greater self-reported anger, lower galvanic skin conductance, and less task persistence (i.e., lower distress tolerance) than non-MDD individuals. Emotion regulation strategy did not differentially attenuate emotional responses between MDD groups. Instructions to accept emotions increased anger for all participants compared to reappraisal and no strategy instructions. Results confirm that enhanced anger reactivity and poor distress tolerance are present in MDD compared to healthy controls. However, additional work is needed to further develop and implement strategies that help people with MDD manage their emotional reactivity and enhance distress tolerance.

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  1. After selecting for individuals in the MDD group, individuals were grouped as yes (n = 26) or no (n = 45) for the presence of an additional Axis I disorder. A 2 (Axis I: yes or no) × 3 (condition) × 2 (time) mixed plot ANOVA was conducted to explore the effects of comorbidities on anger reactivity. Results indicated that individuals who had a comorbid disorder did not differ from those who were exclusively experiencing a major depressive episode in their anger responses over time. Thus, the interaction of Axis I × time was non-significant, (F (1, 65) = 0.01, p = 0.92, η2 = 0.00). Further, there were no condition effects, and the time × Axis I × condition interaction was also non-significant, (F (2, 65) = 0.30, p = 0.74, η2 = 0.01). For distress tolerance, the effect of an additional Axis I disorder was also non-significant, F (1, 72) = 0.39, p = 0.53, η2 = 0.01. The interaction of condition × Axis I disorder was also non-significant, F (2, 72) = 0.61, p = 0.54, η2 = 0.02, indicating that additional Axis I diagnoses did not moderate distress tolerance.

    Within the MDD group, individuals were grouped into those who are currently taking anti-depressants (n = 9) and those who are not (n = 62). A 2 (anti-depressant use: yes or no) × 3 (condition) × 2 (time) mixed plot ANOVA was conducted to explore the effects of medication on anger reactivity. Results indicated that individuals who were taking anti-depressants did not differ from those who were not in their anger responses over time. Thus, the interaction of medication use × time was non-significant, (F (1, 66) = 0.12, p = 0.73, partial η2 = 0.00). Further, there were no condition effects, and the time × medication use × condition interaction was also non-significant, (F (2, 66) = 2.86, p = 0.10, partial η2 = 0.04). For distress tolerance, the effect of medication use was also non-significant, F (1, 67) = 0.07, p = 0.79, partial η2 = 0.00. The condition × medication use interaction was also non-significant, F (2, 67) = 0.65, p = 0.53, partial η2 = 0.02.

  2. During task differences between MDD groups also remained when controlling for time to termination (p = 0.059).

  3. Although MDD groups did not differ on overall skill level during the MTPT-C, we considered it as an important covariate of our interaction effect (i.e., MDD × anger reactivity) on task persistence. When skill was included in the model, additional variance was explained, (R 2 = 0.37, F (4, 168) = 23.7, p < 0.001). The MDD group by anger reactivity interaction remained significant (b = −0.03, β = −0.30, t = −2.81, p = 0.01).

References

  • Albus, M., Muller-Spahn, F., Ackenheil, M., & Engel, R. R. (1987). Psychiatric patients and their response to experimental stress. Stress Medicine, 3, 233–238.

    Article  Google Scholar 

  • Aldoa, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.

    Article  Google Scholar 

  • Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: New American Library.

    Google Scholar 

  • Benazzi, F. (2005). Possible bipolar nature of irritability in major depressive disorder. Journal of Clinical Psychiatry, 66, 1072.

    Article  PubMed  Google Scholar 

  • Bornovalova, M. A., Gratz, K. L., Daughters, S. B., Hunt, E. D., & Lejuez, C. W. (2012). Initial RCT of a distress tolerance treatment for individuals with substance use disorders. Drug and Alcohol Dependence, 122(1–2), 70–76.

    Article  PubMed  Google Scholar 

  • Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: Results from a randomized controlled trial. Behavior Therapy, 43, 365–380.

    Article  PubMed  Google Scholar 

  • Brown, R. A., Lejuez, C. W., & Kahler, C. W. (2002). Distress tolerance and duration of past smoking cessation attempts. Journal of Abnormal Psychology, 111(1), 180–185.

    Article  PubMed  Google Scholar 

  • Bylsma, L. M., Morris, B. H., & Rottenberg, J. (2008). A meta-analysis of emotional reactivity in major depressive disorder. Clinical Psychology Review, 28(4), 676–691.

    Article  PubMed  Google Scholar 

  • Byrne, M. L., Sheeber, L., Simmons, J. G., Davis, B., Shortt, J. W., Katz, L. F., et al. (2010). Autonomic cardiac control in depressed adolescents. Depression and Anxiety, 27, 1050–1056.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders. New York, NY: Guilford Press.

    Google Scholar 

  • Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006a). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587–595.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006b). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251–1263.

    Article  PubMed  Google Scholar 

  • Carroll, D., Phillips, A. C., Hunt, K., & Der, G. (2007). Symptoms of depression and cardiovascular reactions to acute psychological stress: Evidence from a population study. Biological Psychology, 75, 68–74.

    Article  PubMed  Google Scholar 

  • Conner, K. R., Meldrum, S., Wieczorek, W. F., Duberstein, P. R., & Welte, J. W. (2004). The association of irritability and impulsivity with suicidal ideation among 15- to 20- year-old males. Suicide Life Threat Behavior, 34, 363–373.

    Article  Google Scholar 

  • Curran, M. L., Andrykowski, M. A., & Studts, J. L. (1995). Short form of the profile of mood states (POMS-SF): Psychometric information. Psychological Assessment, 7(1), 80–83.

    Article  Google Scholar 

  • Cyders, M. A., & Smith, G. T. (2008). Emotion-based dispositions to rash action: Positive and negative urgency. Psychological Bulletin, 134(6), 807–828.

    Article  PubMed  Google Scholar 

  • Ehring, T., Tuschen-Caffier, B., Schnulle, J., Fischer, S., & Gross, J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10(4), 563–572.

    Article  PubMed  Google Scholar 

  • Elliott, R. (1969). Tonic heart rate: Experiments on the effects of collative variables lead to a hypothesis about is motivational significance. Journal of Personality and Social Psychology, 1969(12), 211–228.

    Google Scholar 

  • Ellis, A. J., Fischer, K. M., & Beevers, C. G. (2010). Is dysphoria about being red and blue? Potentiation of anger and reduced distress tolerance among dysphoric individuals. Cognition and Emotion, 24(4), 596–608.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1998). Structured clinical interview for DSM-IV-TR axis 1 disorders-patient edition (SCID-I/P, 11/2002 revision). New York: Biometrics Research, New York State Psychiatric Institute.

  • Gould, J. (1982). A psychometric investigation of the standard and long form beck depression inventory. Psychological Reports, 51, 1167–1170.

    Article  PubMed  CAS  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.

    Article  Google Scholar 

  • Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299.

    Article  Google Scholar 

  • Gross, J. J. (2001). Emotion regulation in adulthood: Timing is everything. Current Directions in Psychological Science, 10, 214–219.

    Article  Google Scholar 

  • Gross, J. J. (2007). The handbook of emotion regulation. New York: Guilford Press.

    Google Scholar 

  • Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.

    Article  PubMed  Google Scholar 

  • Gross, J. J., & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical Psychology: Science and Practice, 2, 151–164.

    Article  Google Scholar 

  • Hawkins, K. A., Macatee, R. J., Guthrie, W., & Cougle, J. R. Concurrent and prospective relations between distress tolerance, life stressors and anger. Cognitive Therapy and Research. doi:10.1007/s10608-012-9487-y (in press).

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). The ACT model of psychopathology and human suffering. In Acceptance and commitment therapy: An experiential approach to behavior change (pp. 49–80). New York: Guilford Press.

  • Kibler, J. L., & Ma, M. (2004). Depressive symptoms and cardiovascular reactivity to laboratory behavioral stress. International Journal of Behavioural Medicine, 11, 81–87.

    Article  Google Scholar 

  • Kovacs, M., Joormann, J., & Gotlib, I. H. (2008). Emotion (dys)regulation and links to depressive disorders. Child Development Perspectives, 2, 149–155.

    Article  PubMed  Google Scholar 

  • Kring, A. M., & Werner, K. H. (2004). Emotion regulation and psychopathology. In P. Philippot & R. S. Feldman (Eds.), The regulation of emotion (pp. 359–385). Mahwah, NJ: Erlbaum.

    Google Scholar 

  • Lahmeyer, H. W., & Bellur, S. N. (1987). Cardiac regulation and depression. Journal of Psychiatric Research, 21, 1–6.

    Article  PubMed  CAS  Google Scholar 

  • Lehofer, M., Moser, M., Hoehn-Saric, R., McLeod, D., Liebmann, P., Drnovsek, B., et al. (1997). Major depression and cardiac autonomic control. Biological Psychiatry, 42, 914–919.

    Article  PubMed  CAS  Google Scholar 

  • Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in unipolar depression: The effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy,. doi:10.1016/j.brat.2008.08.001.

    PubMed  Google Scholar 

  • Low, C. A., Stanton, A., & Bower, J. (2008). Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation. Emotion, 8(3), 419–424.

    Article  PubMed  Google Scholar 

  • Luutonen, S. (2007). Anger and depression—Theoretical and clinical considerations. Nordic Journal of Psychiatry, 61(4), 246–251.

    Article  PubMed  Google Scholar 

  • Marcks, B. A., & Woods, D. W. (2005). A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: A controlled evaluation. Behaviour Research and Therapy, 43, 433–445.

    Article  PubMed  Google Scholar 

  • Masedo, A. I., & Esteve, M. R. (2007). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45(2), 199–209.

    Article  PubMed  Google Scholar 

  • Matthews, K. A., & Stoney, C. M. (1988). Influences of sex and age on cardiovascular responses during stress. Psychosomatic Medicine, 50, 46–56.

    PubMed  CAS  Google Scholar 

  • Mauss, I. B., Cook, C. L., Cheng, J. Y. J., & Gross, J. J. (2007). Individual differences in cognitive reappraisal: Experiential and physiological responses to an anger provocation. International Journal of Psychophysiology, 66, 116–124.

    Article  PubMed  Google Scholar 

  • Maxwell, J. A. (2004). Using qualitative methods for causal explanation. Field Methods, 16(3), 243–264.

    Article  Google Scholar 

  • McHugh, R. K., Hearon, B. A., Halperin, D. M., & Otto, M. W. (2011). A novel method for assessing distress intolerance: Adaptation of a measure of willingness to pay. Journal of Behavior Therapy and Experimental Psychiatry, 42, 440–446.

    Article  PubMed  Google Scholar 

  • Memedovic, S., Grisham, J. R., Denson, T. F., & Moulds, M. L. (2010). The effects of trait reappraisal and suppression on anger and blood pressure in response to provocation. Journal of Research in Personality, 44, 540–543.

    Article  Google Scholar 

  • Myin-Germeys, I., Peeters, F., Havermans, R., Nicolson, N. A., Delespaul, P., deVries, M., et al. (2003). Emotional reactivity to daily life stress in psychosis and affective disorder: An experience sampling study. Acta Psychiatrica Scandinavica, 107, 124–131.

    Article  PubMed  CAS  Google Scholar 

  • Pàez-Blarrina, M., Luciano, C., Gutiérrez-Martínez, O., Valdivia, S., Rodríguez-Valverde, M., & Ortega, J. (2008). Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive control based protocol. Behavior Modification, 32, 403.

    Article  PubMed  Google Scholar 

  • Perlis, R. H., Fraguas, R., Fava, M., Trivedi, M. H., Luther, J. F., Wisniewski, S. R., et al. (2005). Prevalence and clinical correlates of irritability in major depressive disorder: A preliminary report from the sequenced treatment alternatives to relieve depression study. Journal of Clinical Psychiatry, 66, 159–166.

    Article  PubMed  Google Scholar 

  • Quinn, E. P., Brandon, T. H., & Copeland, A. L. (1996). Is task persistence related to smoking and substance abuse? Applying learned industriousness theory to addictive behaviors. Experimental and Clinical Psychopharmacology, 4, 186–190.

    Article  Google Scholar 

  • Roche, B., Forsyth, J. P., & Maher, E. (2007). The impact of demand characteristics on brief acceptance- and control-based interventions for pain tolerance. Cognitive and Behavioral Practice, 14(4), 381–393.

    Article  Google Scholar 

  • Roemer, L., Lee, J. K., Salters-Pedneault, K., Erisman, S. M., Orsillo, S. M., & Mennin, D. S. (2009). Mindfulness and emotion regulation difficulties in generalized anxiety disorder: Preliminary evidence for independent and overlapping contributions. Behavior Therapy, 40, 142–154.

    Article  PubMed  Google Scholar 

  • Rottenberg, J. M., & Gotlib, I. H. (2004). Socioemotional functioning in depression. In M. Power (Ed.), Mood disorders: A handbook of science and practice (pp. 61–77). New York: Wiley.

    Chapter  Google Scholar 

  • Rottenberg, J. M., Gross, J. J., & Gotlib, I. H. (2005). Emotion context insensitivity in major depressive disorder. Journal of Abnormal Psychology, 114(4), 627–639.

    Article  PubMed  Google Scholar 

  • Segal, Z. V., Teasdale, J. D., & Williams, J. M. G. (2004). Mindfulness-based cognitive therapy: Theoretical rationale and empirical status. In S. Hayes, V. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.

    Google Scholar 

  • Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102.

    Article  Google Scholar 

  • Stanton, A. L., Kirk, S. B., Cameron, C. L., & Danoff-Burg, S. (2000). Coping through emotion approach: Scale construction and validation. Journal of Personality and Social Psychology, 78(6), 1150–1169.

    Article  PubMed  CAS  Google Scholar 

  • Strong, D. R., Lejuez, C. W., Daughters, S., Marinello, M., Kahler, C. W., & Brown, R. A. (2003). The computerized mirror tracing task, version 1 (unpublished manual).

  • Szasz, P. L., Szentagotai, A., & Hofmann, S. G. (2011). The effect of emotion regulation strategies on anger. Behaviour Research and Therapy, 49, 114–119.

    Article  PubMed  Google Scholar 

  • Teasdale, J. D., Segal, Z., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.

    Article  PubMed  CAS  Google Scholar 

  • Tutoo, D. N. (1971). Psychodiagnostic applications of the mirror tracing test. Indian Educational Review, 6, 293–303.

    Google Scholar 

  • Wenze, S. J., Gunthert, K. C., Forand, N. R., & Laurenceau, J. P. (2009). The influence of dysphoria on reactivity to naturalistic fluctuations in anger. Journal of Personality, 77(3), 795–824.

    Article  PubMed  Google Scholar 

  • Williams, J. E., Nieto, F. J., Sanford, C. P., & Tyroler, H. A. (2001). Effects of an angry temperament on coronary heart disease risk: The Atherosclerosis Risk in Communities Study. American Journal of Epidemiology, 154, 230–235.

    Article  PubMed  CAS  Google Scholar 

  • Yong, E. (2012). Replication studies: Bad copy. Nature, 485(17), 298–300.

    Article  PubMed  Google Scholar 

  • Zuckerman, M., Persky, H., & Curtis, G. C. (1968). Relationships among anxiety, depression, hostility and autonomic variables. Journal of Nervous and Mental Disease, 146(6), 481–487.

    Article  PubMed  CAS  Google Scholar 

  • Zvolensky, M. J., Vujanovic, A. A., Bernstein, A., & Leyro, T. (2010). Distress tolerance: Theory, measurement, and relations to psychopathology. Current Directions in Psychological Science, 19, 406.

    Article  Google Scholar 

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Acknowledgments

Preparation for this article was facilitated by the American Fellowship, awarded to Alissa Ellis by the American Association of University Women.

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  1. Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA

    Alissa J. Ellis

  2. The University of Texas at Austin, Austin, TX, USA

    W. Michael Vanderlind & Christopher G. Beevers

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Ellis, A.J., Vanderlind, W.M. & Beevers, C.G. Enhanced Anger Reactivity and Reduced Distress Tolerance in Major Depressive Disorder. Cogn Ther Res 37, 498–509 (2013). https://doi.org/10.1007/s10608-012-9494-z

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