New research has uncovered neural emotion regulation abnormalities in patients with remitted recurrent major depressive disorder. The findings, which appear in the journal NeuroImage: Clinical, shed new light on potential neural mechanisms that facilitate relapse.
“We were interested in this topic because recurrence after remission of depression is a very big problem, both on a personal level and on a societal level,” said study author Rozemarijn S. van Kleef, a psychological therapist at Mentaal Beter.
“We believe it is important to gain further insight into mechanisms underlying this vulnerability. Previous studies suggest that patients with acute depression show abnormalities in brain functioning during processing and regulating negative emotional information. We were interested in studying whether these processes are residually abnormal upon remission, and whether they could explain vulnerability to future relapse.”
The study included 50 participants with rrMDD and 25 control participants. To be included in the study, the depression patients must have had at least two major depressive episodes in the past five years; be currently in remission from their last depressive episodes for more than two months, but no longer than two years; and have no other current psychiatric diagnoses.
The participants completed two assessments of rumination, which focused on ruminative thinking about sadness and rumination in response to positive affect. They also completed the Emotion Regulation Questionnaire, which measures the extent to which people use expressive suppression and cognitive reappraisal to manage their emotions.
Van Kleef and her colleagues found that the depression patients tended to report more dysfunctional emotion regulation strategies compared to the control participants. Depression patients were more likely to ruminate on negative content and reported a higher tendency to dampen positive feelings in the face of positive affect. Depression patients also reported using cognitive reappraisal less and expressive suppression more.
To examine emotion regulation at the neural level, the researchers had the participants complete an emotional regulation task while undergoing functional magnetic resonance imaging scanning. The participants were shown pictures that contained emotionally neutral, emotionally negative, or emotionally positive content. They were asked to either passively observe the picture, apply cognitive reappraisal techniques to reduce the intensity of negative emotions, or attempt to increase the intensity of positive emotions. The participant received training on the emotional regulation techniques prior to scanning.
Van Kleef and her colleagues found that the depression patients exhibited a different pattern of brain activity compared to controls when asked to passively observe emotional images and when asked to increase the intensity of positive emotions.
“More specifically, rrMDD patients showed lower activation in areas within a visual-parietal-prefrontal network, and different temporal dynamics in parietal areas during attending emotional images, but no clear abnormalities during explicit negative emotion regulation. During explicit regulation of positive emotions, rrMDD patients showed differential temporal dynamics in dorsal anterior insula activation,” the researchers explained.
The findings indicate that “how positive emotions are being processed and regulated is important for understanding vulnerability to relapse after remission of depression,” van Kleef told PsyPost. In addition, “how remitted patients are capable of regulating negative emotions when they are explicitly instructed to do so does not seem to be different than people who have never been depressed. However, when they are confronted with emotional information without instruction, or in daily life, they seem to use less functional regulation strategies, for example rumination.”
As far as the study’s limitations, van Kleef noted that the findings only represent cross-sectional data. “It would be very interesting to further investigate what the value of these residual abnormalities is for predicting future relapse,” she said. “This is something we would like to investigate, using follow-up data from our NEWPRIDE study.”
“Our findings may have important clinical implications: normalizing the experiencing and savoring of positive emotions and training flexible initiation of functional regulation strategies in the face of negative emotions in daily life, may be critical therapeutic targets when it comes to relapse prevention,” van Kleef added.
The study, “Neural basis of positive and negative emotion regulation in remitted depression“, was authored by Rozemarijn S. van Kleef, Jan-Bernard C. Marsman, Evelien van Valen, Claudi L.H. Bockting, André Aleman, and Marie-José van Tol.