Recognition of emotion from body language among patients with unipolar depression
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
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