Elsevier

Psychiatry Research

Volume 209, Issue 1, 30 August 2013, Pages 40-49
Psychiatry Research

Recognition of emotion from body language among patients with unipolar depression

https://doi.org/10.1016/j.psychres.2013.03.001Get rights and content

Abstract

Major depression may be associated with abnormal perception of emotions and impairment in social adaptation. Emotion recognition from body language and its possible implications to social adjustment have not been examined in patients with depression. Three groups of participants (51 with depression; 68 with history of depression in remission; and 69 never depressed healthy volunteers) were compared on static and dynamic tasks of emotion recognition from body language. Psychosocial adjustment was assessed using the Social Adjustment Scale Self-Report (SAS-SR). Participants with current depression showed reduced recognition accuracy for happy stimuli across tasks relative to remission and comparison participants. Participants with depression tended to show poorer psychosocial adaptation relative to remission and comparison groups. Correlations between perception accuracy of happiness and scores on the SAS-SR were largely not significant. These results indicate that depression is associated with reduced ability to appraise positive stimuli of emotional body language but emotion recognition performance is not tied to social adjustment. These alterations do not appear to be present in participants in remission suggesting state-like qualities.

Introduction

Major depressive disorder represents a significant and common cause of disability and social impairment (Kessler et al., 2003, Richards, 2011). Its frequency and burden are expected to increase in years to come (Monroe and Harkness, 2011). Individuals affected by unipolar depression continue to exhibit diminished psychosocial adjustment in multiple domains of functioning during the remission phase of the illness (Wells et al., 1989, Coryell et al., 1993, Hays et al., 1995, Shapira et al., 1999). Psychosocial adaptation reflects an individual's functioning and satisfaction in multiple social roles (e.g., family, work environment, friends) and is the result of a complex interplay of personal needs/wants and social demands (for further insights see Figueira and Brissos (2011)). The reasons behind psychosocial impairment in depression are not well understood (Hammen et al., 2009). One hypothesis suggests that a significant underpinning is abnormal emotion recognition from socially relevant stimuli (Ridout et al., 2007, Bourke et al., 2010, Bistricky et al., 2011).

As a whole, results of emotion recognition in depression have not been entirely consistent. Some investigators have shown that persons with depression exhibit impaired recognition of happy stimuli (Walker, 1981; Mandal and Bhattacharya, 1985, Surguladze et al., 2004; Csulkly et al., 2009) while others have not (Cooley and Nowicki, 1989, Gur et al., 1992; Rubinow and Post, 1992, Persad and Polivy, 1993, Leppanen and Hietanen, 2004; Kan et al., 2004; Csulkly et al., 2009). Adding further complexity to the issue, in some studies, depression was associated with impaired recognition of negative emotions (e.g., angry, fearful and sad stimuli) (Feinberg et al., 1986, Rubinow and Post, 1992, Persad and Polivy, 1993, Asthana et al., 1998). Whereas impairment in recognition of happiness is mood congruent, reduced recognition of negative emotions is arguably a less mood congruent feature.

The studies discussed above were based on emotions portrayed by facial expressions, and in fact, emotion perception research in depression has primarily used human face stimuli neglecting the universe of emotional body language (Coulson, 2004). Findings attained using facial expressions are often extrapolated as indicators of the category of socially relevant stimuli as a whole. Novel and complementary insights may emerge when expanding the study of emotion perception to emotional body language (EBL, de Gelder, 2006, Hinzman and Kelly, 2012). In addition, the study of perception of EBL in depression fills a critical niche because the brain circuits processing EBL stimuli are only partially overlapping with the brain circuits processing facial expressions (de Gelder, 2006) and may be differentially affected by the depressive illness.

Body language may be defined as the collection of signs (e.g., posture, speed of movement, meaningful coordination of actions) expressed by the human body (Watzlawick et al., 1967, de Gelder, 2006, Schindler et al., 2008). Body language conveys a significant amount of emotionally and socially relevant information (Adolphs and Tranel, 2003, Heberlein et al., 2004, Bigelow et al., 2006, Atkinson et al., 2007). Perception of body language has been estimated to constitute up to 60–70% of human social communication (Burgoon, 1985). People who are able to correctly perceive body language signals tend to experience more meaningful relationships, greater social approval (Hodgins and Zuckerman, 1990) and competence (Seay and Altekruse, 1979; Noller, 1980, Trower, 1980). This is not surprising considering that facial expressions and body postures signal relevant information about emotional behaviors and intentions (Ekman, 1993, de Gelder, 2006) and that they are continuously appraised during social interactions (Bouhuys et al., 1999). Whereas EBL has been the subject of several studies in healthy participants (Coulson, 2004), schizophrenia (Bigelow et al., 2006), alcohol use disorder (Maurage et al., 2009), and focal brain damage (Heberlein and Saxe, 2005, Atkinson et al., 2007), to date, EBL has never been studied in depression (Coulson, 2004, Meeren et al., 2005, Calvo-Merino et al., 2008, Van den Stock et al., 2009).

Emotion perception in general and perception of EBL in particular may relate to social adaptation, a critical outcome measure in depression studies (Paradiso et al., 2011). A relationship between change in perception of socially relevant stimuli and poorer social adaptation in depression has been often posited but not empirically tested (Hodgins and Zuckerman, 1990, Ridout et al., 2003, Yoon et al., 2009, Gollan et al., 2010). One partial exception is a study that examined the association between emotion perception and psychological aggression towards sentimental partners as a function of depressive tendencies (Marshall et al., 2011). This study did not include individuals diagnosed with major depression (Marshall et al., 2011).

The present study examined perception of emotions across different body language stimuli in patients with unipolar major depression. Stimuli were included to examine perceptual responses to distinct facets of EBL including single body stimuli, stimuli depicting social interaction and socially relevant stimuli in motion. This approach was planned with the intent to capture the complexity of emotion perception and allowed assessment of consistency and differences of responses for differing types of stimuli. Dynamic stimuli were chosen based on the evidence that static and dynamic stimuli are processed by partially differing brain structures (Downing et al., 2001, Adolphs et al., 2003). Dynamic stimuli were added also because emotions in real-life are often conveyed by stimuli in motion (Kan et al., 2004, Hoffmann et al., 2006). Analyses were planned to study the effects of static and dynamic tasks as a function of diagnosis. Considering the dearth of studies on EBL in depression and the inconsistencies in the literature on depression and emotion perception from face stimuli, specific predictions on valence and direction of potential abnormalities were not made.

Examination of perception of EBL during remission was also a focus of the present report. This aspect of the present research was planned based on studies suggesting that alterations in the processing of social stimuli may continue into remission (Leppanen and Hietanen, 2004, LeMoult et al., 2009) but also on views that some alterations of brain activity in depression may revert to normalcy following remission (Drevets, 1998, Mayberg et al., 1999, Sheline et al., 2001, Drevets et al., 2002). Finally, analyses were planned to examine the association between variables showing a significant group effect on perception of EBL and psychosocial adaptation. It was expected that depression would be characterized by alterations in emotion perception and these would correlate with poorer social adaptation.

Section snippets

Participants

The study sample consisted of 51 patients examined during an active episode of depression, 68 examined while in remission (estimated mean time in remission in months=50.7; S.D.=54.9) and 69 healthy comparison participants (i.e., reporting no life-time episodes of depression) recruited from the University of Iowa Departments of Internal Medicine and Psychiatry inpatient and outpatient services and from the Iowa City Veterans Administration Medical Center Primary Care service and through

Point-Light Walkers

Table 3 shows group means and standard deviations for all emotions within each task. The main effect of group on happy stimuli for PLWs was found to be significant (F (2; 186)=3.6; P=0.029; Cohen's f=0.20). Post-hoc tests indicated that participants with current depression scored significantly lower on happy stimuli than subjects in remission (P=0.018) and healthy comparison participants (P=0.019). The difference between healthy comparison and remission groups did not reach conventional levels

Discussion

Perception of emotion through body language has been shown to be a promising measure of social cognition and posited to be a factor potentially influencing social adaptation (Seay and Altekruse, 1979, Noller, 1980, Trower, 1980, Hodgins and Zuckerman, 1990). To our knowledge this is the first study to examine perception of emotion in body stimuli in individuals with clinical depression. The findings in the present study indicated that patients with current depression displayed poorer emotion

Acknowledgments

The authors thank Lavanya Vijayaraghavan, MBBS, MSc. for her valuable comments on this research and Erika Holm-Brown for data collection. Thanks to Ralph Adolphs for his supportive mentorship to Sergio Paradiso and to Andrea Heberlein for providing some of the stimuli used in this study. Sergio Paradiso was supported by the Dana foundation, the Mallinckrodt foundation, NARSAD and the National Institute on Aging (5K23AG027837). Felice Loi expresses his gratitude to Anna Maria Fogliani, Director

References (120)

  • W. Hale

    Judgment of facial expressions and depression persistence

    Psychiatry Research

    (1998)
  • A.S. Heberlein et al.

    Dissociation between emotion and personality judgments: convergent evidence from functional neuroimaging

    Neuroimage

    (2005)
  • P.J. Johnston et al.

    A generalised deficit can account for problems in facial emotion recognition in schizophrenia

    Biological Psychology

    (2001)
  • T. Kirita et al.

    Happy face advantage in recognizing facial expressions

    Acta Psychologica

    (1995)
  • W. Liu et al.

    Facial perception bias in patients with major depression

    Psychiatry Research

    (2012)
  • E.S. Mikhailova et al.

    Abnormal recognition of facial expression of emotions in depressed patients with major depression disorder and schizotypal personality disorder

    Biological Psychiatry

    (1996)
  • F.E. Pollick et al.

    Perceiving affect from arm movement

    Cognition

    (2001)
  • D. Richards

    Prevalence and clinical course of depression: a review

    Clinical Psychology Review

    (2011)
  • N. Ridout et al.

    Emotion recognition from dynamic emotional displays following anterior cingulotomy and anterior capsulotomy for chronic depression

    Neuropsychologia

    (2007)
  • D.R. Rubinow et al.

    Impaired recognition of affect in facial expression in depressed patients

    Biological Psychiatry

    (1992)
  • T. Ruffman et al.

    A meta-analytic review of emotion recognition and aging: implications for neuropsychological models of aging

    Neuroscience and Biobehavioral Reviews

    (2008)
  • K. Schindler et al.

    Recognizing emotions expressed by body pose: a biologically inspired neural model

    Neural Networks

    (2008)
  • R. Adolphs et al.

    Cortical systems for the recognition of emotion in facial expressions

    The Journal of Neuroscience

    (1996)
  • R. Adolphs

    Recognizing emotion from facial expressions: psychological and neurological mechanisms

    Behavioral and Cogntive Neuroscience Review

    (2002)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders

    (2005)
  • I.M. Anderson et al.

    State-dependent alteration in face emotion recognition in depression

    The British Journal of Psychiatry

    (2011)
  • M.P. Austin et al.

    Cognitive function in major depression

    Journal of Affective Disorders

    (1992)
  • A.L. Benton et al.

    Facial recognition: stimuli and multiple choice pictures

    (1983)
  • A.L. Benton et al.

    Visuospatial judgment. A clinical test

    Archives of Neurology

    (1978)
  • S.L. Bistricky et al.

    Facial Affect processing and depresion susceptibility: cognitive biases and cognitive neuroscience

    Psychological Bulletin

    (2011)
  • A.L. Bouhuys et al.

    Depressed patients' perceptions of facial emotions in depressed and remitted states are associated with relapse: a longitudinal study

    Journal of Nervous and Mental Disease

    (1999)
  • C. Bourke et al.

    Processing of facial emotion expression in major depression: a review

    Australian and New Zealand Journal of Psychiatry

    (2010)
  • J.K. Burgoon
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences, revised edition

    (1977)
  • E.L. Cooley et al.

    Discrimination of facial expressions of emotion by depressed subjects

    Genetic Social and General Psychology Monographs

    (1989)
  • W. Coryell et al.

    The enduring psychosocial consequences of mania and depression

    The American Journal of Psychiatry

    (1993)
  • M. Coulson

    Attributing emotion to static body postures: recognition, accuracy, confusions, and viewpoint dependence

    Journal of Nonverbal Behavior

    (2004)
  • S.M. Couture et al.

    Comparison of social cognitive fuctioning in schizophrenia and high functioning autism: more convergenge than divergence

    Psychological Medicine

    (2010)
  • G. Csukly et al.

    Facial expression recognition in depressed subjects: the impact of intensity level and arousal dimension

    Journal of Nervous and Mental Disease

    (2009)
  • B. de Gelder et al.

    Fear fosters flight: A mechanism for fear contagion when perceiving emotion expressed by a whole body

    Proceedings of the National Academy of Sciences of the United States of America

    (2004)
  • B. de Gelder

    Towards the neurobiology of emotional body language

    Nature Reviews Neuroscience

    (2006)
  • L.R. Demenescu et al.

    Impaired attribution of emotion to facial expressions in anxiety and major depression

    PLoS One

    (2010)
  • E. Diener et al.

    Most people are happy

    Psychological Science

    (1996)
  • W.H. Dittrich et al.

    Perception of emotion from dynamic point-light displays represented in dance

    Perception

    (1996)
  • K.M. Douglas et al.

    Recognition of disgusted facial expressions in severe depression

    The British Journal of Psychiatry197

    (2010)
  • P.E. Downing et al.

    A cortical area selective for visual processing of the human body

    Science

    (2001)
  • W.C. Drevets

    Functional neuroimaging studies of depression: the anatomy of melancholia

    Annual Review of Medicine

    (1998)
  • P. Ekman et al.

    Pan-cultural elements in facial displays of emotion

    Science

    (1969)
  • P. Ekman

    Facial expression and emotion

    American Psychologist

    (1993)
  • F. Esteves et al.

    Masking the face: recognition of emotional facial expressions as a function of the parameters of backward masking

    Scandinavian Journal of Psychology

    (1993)
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