Emotion Regulation Strategy Choice In Depression: Choosing to Avoid the Positive?

Millgram, Y., Mizrahi Lakan, S., Joormann, J., Nahum, M., Shimony, O., & Tamir, M. (2023). Choosing to avoid the positive? Emotion regulation strategy choice in depression. Journal of Psychopathology and Clinical Science, 132(6), 669–680. https://doi.org/10.1037/abn0000835

Key Points

• Depressed individuals were more likely than healthy controls to choose distraction over positive rumination when regulating their emotions in response to pleasant autobiographical memories. This resulted in reduced positive affect for the depressed group.
• When instructed to choose the emotion regulation strategy that would make them feel the most positive, the strategy choices of depressed and healthy participants did not differ. This suggests that while depressed individuals have knowledge of effective regulation strategies, they do not spontaneously choose such strategies.
• Daily assessments confirmed that compared to healthy controls, people with depression reported using more distraction from pleasant emotions in daily life. They did not differ in positive rumination.
• The use of distraction from pleasant emotions was related to increased motivation to experience unpleasant emotions in daily life. The motivation for unpleasant emotions also predicted lower positive affect and higher negative affect over time among depressed participants.

Rationale

Emotion regulation strategy use exists on a spectrum from involuntary reflexive reactions to deliberate, conscious choices between strategies (O’Doherty et al., 2017).

Prior research demonstrates that depressed individuals implement emotion regulation strategies like distraction from positive stimuli and negative rumination more often than healthy people (Yoon & Rottenberg, 2020).

However, most research relies on self-report, which memory biases can influence (Marchetti et al., 2018). When depressed individuals self-report on emotion regulation strategy use retrospectively, it is unclear what processes these reports reflect.

Therefore, when emotion regulation strategy selection has been assessed via self-report in past depression research, it remains ambiguous whether findings reflect deliberate, actively made choices or other processes (Liu & Thompson, 2017).

There is a need to behaviorally measure active choices between emotion regulation strategies in depression to clarify what is driving strategy selection and implementation. This can determine if certain strategies are preferentially chosen versus involuntarily used.

The key issue is that the degree of conscious, deliberate control depressed individuals can exert over emotion regulation strategy use has been unclear up till now. Assessing active choices instead of self-reported use can elucidate issues of selection versus involuntary implementation in depression.

The research also examined if strategy choices are related to motivations for pleasant or unpleasant emotions. Understanding patterns of strategy selection in depression can clarify whether certain regulatory responses are deliberately chosen versus involuntary.

Method

• Study 1: 38 clinically depressed and 39 healthy participants recalled positive and negative autobiographical memories and chose to respond using either rumination or distraction. This was repeated in two blocks – one where participants made spontaneous choices, and one where they were instructed to choose the feeling-improving strategy.
• Study 2: Using daily experience sampling over ten days in another sample, 58 depressed and 62 healthy participants reported their use of rumination and distraction for pleasant and unpleasant emotions. They also rated their motivation to experience pleasant and unpleasant discrete emotions over the past 2 hours.

Results

• Study 1: depressed participants showed a greater preference for using distraction over positive rumination when spontaneously regulating pleasant memories, compared to healthy controls.
• When instructed to pick feeling-improving strategies, the choices of depressed and controls did not differ for pleasant memories. This suggests some knowledge of helpful strategies for depression.
• Study 2: daily assessments confirmed depressed individuals distract from pleasant emotions more than healthy people. They also reported greater motivation for unpleasant emotions, which predicted the use of distraction from positive emotions and negative rumination.

Insight

A key insight from this research is that depressed individuals seem to avoid positive rumination in response to positive events, even when they could choose more adaptive emotion regulation strategies.

The fact that instructions to improve feelings changed strategy selections highlights that knowledge about helpful regulation is retained in depression – spontaneous choices just tend not to access it.

Another notable finding is that increased motivation for unpleasant emotions has downstream effects in predicting the type of regulation individuals select on a daily basis.

Together, these results further an understanding of emotion regulation deficits in depression, suggesting deliberate choices driven partly by mood-worsening motivational biases.

Strengths

• The multimethod approach using controlled experiments and daily sampling provides stronger evidence than using one methodology alone.
• The depressed sample was rigorously diagnosed using gold-standard clinical interviews to ensure their symptoms matched diagnostic criteria for major depressive disorder specifically.
• The study improved on past self-reports by assessing active choices between emotion regulation strategies in the lab. Comparing spontaneous and instructed conditions was also innovative.
• A strength of the daily dairy study was measuring both emotion regulation implementation and motivation for emotions within the same participants. This helped elucidate their interrelation.

Limitations

• As student samples of depressed individuals were used, results may not generalize to more diverse, clinical depressed populations. Replication in larger community samples would strengthen conclusions.
• The possible influence of extraneous variables like cognitive deficits could not be ruled out when interpreting choices. Future research might measure and control for such factors.
• Motivation for specific pleasant and unpleasant emotions was examined in daily life. Linking motivation for general positive/negative affect to choices would better match lab assessments.
• Causality cannot be determined for motivation predicting regulation selections using correlational ecological momentary assessments (EMA) data. Experimental manipulation of motivation could ascertain causal effects.

Implications

Clinically, the findings suggest that interventions aiming to alter maladaptive emotion regulation in depression may benefit from addressing underlying motivations that drive choices. Activating goals for pleasant emotions could encourage better spontaneous strategy picks.

Training could also focus on accessing knowledge individuals retain about adaptive regulation techniques. Ultimately, helping depressed persons implement helpful regulation in daily life could improve clinical outcomes and functioning.

Theoretically, the research bridges perspectives on deficits in regulation selection in depression being either deliberate choices or involuntary habits. By demonstrating some active, motivation-influenced choices are made, the field better appreciates the complexity of dysregulated emotions in depression.

References

Primary reference

Millgram, Y., Mizrahi Lakan, S., Joormann, J., Nahum, M., Shimony, O., & Tamir, M. (2023). Choosing to avoid the positive? Emotion regulation strategy choice in depression. Journal of Psychopathology and Clinical Science, 132(6), 669–680. https://doi.org/10.1037/abn0000835

Other references

Liu, D. Y., & Thompson, R. J. (2017). Selection and implementation of emotion regulation strategies in major depressive disorder: An integrative review. Clinical Psychology Review, 57, 183–194. https://doi.org/10.1016/j.cpr.2017.07.004

Marchetti, I., Everaert, J., Dainer-Best, J., Loeys, T., Beevers, C. G., & Koster, E. H. W. (2018). Specificity and overlap of attention and memory biases in depression. Journal of Affective Disorders, 225, 404–412. https://doi.org/10.1016/j.jad.2017.08.037

O’Doherty, J. P., Cockburn, J., & Pauli, W. M. (2017). Learning, reward, and decision making. Annual Review of Psychology, 68(1), 73–100. https://doi.org/10.1146/annurev-psych-010416-044216

Yoon, S., & Rottenberg, J. (2020). Why do people with depression use faulty emotion regulation strategies? Emotion Review, 12(2), 118–128. https://doi.org/10.1177/1754073919890670

Keep Learning

Here are some suggested Socratic discussion questions about this paper for a college class:

• Can you think of alternative explanations besides motivation that could account for the emotion regulation choices exhibited by depressed participants? How might future research distinguish between motivational and non-motivational accounts?
• What might be some reasons why the depressed group showed deficits in regulating positive but not negative information? Does this pattern align with other areas of functioning in depression?
• Do you expect the relationships found here between regulation choices, motivation for emotions, and clinical depression to be similar or different across cultures? What mediators and moderators might influence cultural variability?
• How could parents and educators shape emotional motivations and regulation tendencies early in life to prevent maladaptive patterns that increase depression vulnerability? Would certain parenting practices be recommended?