Dysfunctional emotion regulation is often reported in affective disorders, but it is unclear whether this dysfunction concerns initial processing of emotional input or regulation of resulting emotion. The present study addressed these aspects in 27 depressive and 15 borderline personality disorder patients and 28 healthy controls who were instructed to either passively view unpleasant and neutral pictures or downregulate emotional responses by reappraisal, while neuromagnetic brain activity was measured. All three groups showed more early response to unpleasant than to neutral pictures, whereas patients failed to show subsequent activity suppression under instructions to down-regulate. This deficient emotion regulation was evident primarily in those subjects reporting high childhood adversity. Results support intact emotional input processing but impaired emotion regulation in affective disorders and indicate a moderating influence of early life stress.
Impaired emotion regulation is often discussed as characteristic of disorders of affect. It is reported for major depressive disorder (MDD, [
Emotion dysregulation has been inferred from hemodynamic neuroimaging findings of reduced ventromedial frontal activity during reappraisal, affect discrimination, and emotional Stroop tasks in patients with MDD [
Hemodynamic neuroimaging results may not be sufficient to elucidate the temporal dynamics of emotion regulation, that is, how this interplay unfolds across time. Electro-(EEG) and magnetoencephalography (MEG) complement hemodynamic neuroimaging evidence of these dynamics with better temporal resolution. In healthy subjects, Moser and colleagues [
An additional motivation of the present study was to identify a potential impact of childhood adversity on emotion regulation. Various phenomena have been discussed as contributing to dysfunctional emotion regulation in affective disorders, among them childhood adversity. Adverse experiences early in life are believed to modify emotion processing throughout life via impact on stress reactivity [
Three hypotheses were examined. (1) If the input-oriented aspects of emotion regulation imply perceptual appraisal, an early modulation of event-related activity should be expected [
Twenty-seven inpatients with MDD, 15 with BPD, and 28 participants without psychological diagnoses volunteered to participate (see Table
Demographic and clinical information for groups.
Healthy control (HC, | Major depressive disorder (MDD, | Borderline personality disorder (BPD, | Group effects | |
---|---|---|---|---|
Gender (m/f) | 13/15 | 16/11 | 1/14 | Patient-HC: n.s. |
MDD-BPD: Chi2(2) = 11.1** | ||||
Age (M ± SD) | Patients-HC: n.s. | |||
HC and BPD < MDD** | ||||
Years of education | Patients-HC: | |||
(M ± SD) | MDD-BPD n.s. | |||
BDI (M ± SD) | Patients-HC: | |||
MDD-BPD: n.s., | ||||
ERQr (M ± SD) | Patients-HC: | |||
ERQs (M ± SD) | Patients-HC: | |||
Stress load (number of events) | BPD-MDD n.s. | |||
The protocol was approved by the ethics committee of the University of Konstanz. Prior to the study, participants were informed in detail about the procedures and provided written informed consent. Then they were instructed about strategies of emotion downregulation by reappraisal. (The following instruction about the experiment was given to the participants. In the following you will see neutral and unpleasant pictures, which you will appear for about 2 sec. Before every picture you will see a black screen with a cross in the middle for about 2 sec as well. This cross could be white or blue. The white cross signals you just to watch the picture that follows. This picture could be either a neutral or an unpleasant one. After the blue cross there will show up an unpleasant picture. Unpleasant picture can make you feel stressed or uneasy. To diminish this feeling you should try one of the following strategies. You can prepare yourself by thinking that the scene in the unpleasant picture is not real or from a movie. Or you can try to think the scene in the unpleasant picture will have a positive ending. Like when you see an injured person on the picture you can think that the person will get some help and will be fine. But what you should not do is to think of some unrelated thoughts that will lighten up your emotions like “Today is a nice day,” because you should work with the contents of the pictures. Which of the strategies do you think will work best for you? The blue cross signals you to perform the strategy that works better for you to down-regulate your emotions. Just to make it easier for you we let you know what pictures you will see. The neutral pictures show some normal looking faces and household objects. The unpleasant pictures show harassment by animals or humans and mutilations.). During practice trials sample pictures (not presented during subsequent MEG recording) were presented with the instruction to verbalize the selected strategy to down-regulate the response to the unpleasant pictures. If necessary, subjects were coached on strategy. As a manipulation check participants were asked to report after the experiment what strategies they had used for downregulation. Participants received a bonus of 50 € for completing the experimental session and the interview (see below), which altogether lasted 3-4 hours.
The stimulus set comprised 30 unpleasant, high-arousing and 30 neutral, low-arousing color images taken from the International Affective Picture System (IAPS; [
Participants were asked to fix their gaze on the middle of the screen and to avoid eye and head movements. Each trial started with the presentation of a white or blue cross, which appeared in the center of the screen for 2000 ms and served as a cue for picture emotion type and instruction. At cross offset, a picture appeared for 2000 ms. Trials were separated by picture offset to cross-onset intervals of 2000–2500 ms. The white cross was a signal that a neutral or unpleasant picture would be presented at the offset of the cross and that participants were to view it passively. The blue cross signaled that an unpleasant picture was coming, during which participants were instructed to implement the previously trained mental strategy to down-regulate their emotional response to the picture. Thus, 30 watch-neutral trials, 30 watch-unpleasant trials, and 30 down-regulate-unpleasant trials were presented, in pseudorandom order.
Childhood adverse experiences were assessed in an interview on a different day than the MEG session. The interview used the German version of the Early Trauma Inventory (ETI [
High-resolution MEG and nonparametric cluster-based analyses were used. Event-related magnetic fields (ERFs) in scalp sensor space served to examine the temporal sequence of perception-regulation processes as described in [
Data analyses were based on the time course of ERFs from 500 ms before to 1000 ms after picture onset for the 28 healthy control subjects (HC, see Figure
(a) Time course of field strength around picture onset at 0 ms for watch-neutral (solid black lines), watch-unpleasant (solid blue lines), and down-regulate-unpleasant conditions (dotted blue lines) for healthy control participants (HC). The left panel illustrates left-hemisphere sensors, the right panel right-hemisphere sensors. In- and outgoing magnetic fields explain the opposite direction of the effect. Periods during which conditions differ significantly are marked in yellow for watch-unpleasant versus watch-neutral (Emotion effect) and in brown for watch-unpleasant versus down-regulate-unpleasant (Instruction effect). The center panel presents
After cluster identification, group and condition effects were statistically evaluated at a sensor in the middle of the significant left-hemisphere sensor cluster having the maximum field strength in each participant. A sensor in the middle of the cluster was chosen to avoid effects of unrelated neighboring activity. Resulting scores were evaluated in separate ANOVAs with the orthogonal between-subject factors Group (patients versus HC) or Diagnosis (MDD versus BPD) and the within-subject factors Emotion (watch-neutral versus watch-unpleasant) or Instruction (watch-unpleasant versus down-regulate-unpleasant).
An additional ANOVA evaluated the impact of childhood adversity in patients with the between-subjects factor Stress group. Assignment to the high-stress or low-stress group was based on the total number of adverse events experienced across age 3–16 as reported in the interview. Those in the upper 30% of the distribution (
An initial manipulation check demonstrated findings in the present MEG data set similar to those in EEG ERP studies. Figure
Unpleasant pictures prompted a different pattern of results later in the trial. Figure
As shown for HC in Figure
With present MEG data essentially replicating an earlier emotion effect and a later instruction effect [
(a) Time course of field strength around picture onset at 0 ms and sensor clusters of statistical differences between conditions defining the Emotion effect for MDD patients (top) and BPD patients (bottom). Line types and so forth as in Figure
Responses to cross cues were smaller in patients than in HC (Figure
Time course of field strength as in Figure
The final hypothesis was about the effect of childhood adversity on emotion processing and/or on instruction to down-regulate. During picture presentation, patients with low stress load exhibited effects of emotion regulation similar to those of HC, whereas patients with high stress load did not (Figure
Top: time course of field strength around picture onset at 0 ms (as in Figures
Stress load around puberty (age 9–13) varied with BDI depression in MDD (
The present neuromagnetic results provided support for hypothesis 2 (over hypothesis 1) and for hypothesis 3. Results confirmed a normal sequence of event-related brain responses modulated by experimental variables [
Differential ERFs in response to the cross cue stimuli did not suggest any abnormality associated with affective disorder. These differential responses were related to stimulus frequency rather than to stimulus meaning. Larger EEG ERP amplitude to rare than to frequent stimuli is a common finding, known as the “oddball” effect (e.g., [
Fronto-temporal neuromagnetic activity distinguished responses to unpleasant and neutral stimuli similarly across groups. However, patients did not show normal activity suppression when instructed to down-regulate emotion to unpleasant stimuli. Thus, present results suggest a specific impairment of emotion regulation in patients with affective disorders. Hemodynamic imaging studies have related dysfunctional emotion regulation to reduced prefrontal activity. In the present MEG data, this was presumably manifest in the lack of differential activity at frontotemporal sensor clusters. This conclusion is in line with reports of temporal hypofunction in depression [
Deficient emotion regulation in patients may have resulted from generally reduced cognitive processing efficiency, hence, less efficient implementation of cognitive reappraisal strategies. MDD patients, who have been reported to suffer from cognitive deficits, may have been particularly impaired in implementing instructions for down-regulation by cognitive reappraisal. Indeed, patients not only failed to show ERF differentiation under down-regulation instruction but showed smaller responses to the signal instructing downregulation. Group differences were prominent in left-hemisphere, central-posterior regions that may be associated with the translation of the nonverbal signal (cross) into a working-memory-based verbal representation of the previously learned strategies of reappraisal. This result might suggest a failure to adequately process the instruction and, as a consequence, implement the down-regulation instruction properly, while the automatic differential response to arousing pictures was unaffected by this cognitive deficit. However, as patients exhibited similarly significant differences between the different cross cue stimuli, a general failure to cognitively process signal stimuli seems unlikely. Moreover, the manipulation check and the emotion regulation by instruction in patients without history of childhood adversity argue against general cognitive deficits explaining away the lack of regulation effect. Finally, cognitive dysfunction constitutes a prominent symptom in major depression, whereas disturbed executive function of a different sort is primarily reported in BPD [
The present assessment of emotion regulation was restricted to the down-regulation instruction and to unpleasant stimuli. In healthy subjects, similar effects of regulation instructions have been reported for pleasant stimuli [
Marked experience of childhood adversity modified emotion regulation, supporting hypothesis 3. Without such experiences, normal emotion regulation occurred to some extent in patients with affective disorders. An impact of early life stress on emotion processing has been proposed and explained by stress-mediated alterations of reward processing and motivation states [
To conclude, dysfunctional emotion regulation has been discussed for affective disorders without specifying whether emotional input processing and/or response regulation are primarily affected. For patients with MDD and BPD the present study confirmed deficient instructed downregulation of responses to unpleasant pictures in an experimental task, whereas the differential processing of unpleasant relative to neutral stimuli proved to be unimpaired. Although causal links cannot be inferred from the present results, they suggest that adverse childhood experiences influence emotion regulation.
Research was supported by the Deutsche Forschungsgemeinschaft (FOR751, B5). The authors gratefully acknowledge the advice of Robert F. Simons on study design and analysis and on paper preparation and the assistance of Sabine Scheermesser, Ursula Lommen, and Johanna Fiess in data collection and preprocessing.