scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Perceiving social pressure not to feel negative predicts depressive symptoms in daily life

12 May 2017-Depression and Anxiety (Depress Anxiety)-Vol. 34, Iss: 9, pp 836-844
TL;DR: Western societies often overemphasize the pursuit of happiness, and regard negative feelings such as sadness or anxiety as maladaptive and unwanted.
Abstract: Background Western societies often overemphasize the pursuit of happiness, and regard negative feelings such as sadness or anxiety as maladaptive and unwanted. Despite this emphasis on happiness, the amount of people suffering from depressive complaints is remarkably high. To explain this apparent paradox, we examined whether experiencing social pressure not to feel sad or anxious could in fact contribute to depressive symptoms. Methods A sample of individuals (n = 112) with elevated depression scores (Patient Health Questionnaire [PHQ-9] ≥ 10) took part in an online daily diary study in which they rated their depressive symptoms and perceived social pressure not to feel depressed or anxious for 30 consecutive days. Using multilevel VAR models, we investigated the temporal relation between this perceived social pressure and depressive symptoms to determine directionality. Results Primary analyses consistently indicated that experiencing social pressure predicts increases in both overall severity scores and most individual symptoms of depression, but not vice versa. A set of secondary analyses, in which we adopted a network perspective on depression, confirmed these findings. Using this approach, centrality analysis revealed that perceived social pressure not to feel negative plays an instigating role in depression, reflected by the high out- and low instrength centrality of this pressure in the various depression networks. Conclusions Together, these findings indicate how perceived societal norms may contribute to depression, hinting at a possible malignant consequence of society's denouncement of negative emotions. Clinical implications are discussed.

Summary (3 min read)

Introduction

  • Prevalence rates of Major Depressive Disorder (MDD) in Western societies are remarkably high.
  • Recent studies also point to detrimental consequences of the pressure to feel happy and not sad.
  • In particular, the authors examined whether the perceived pressure not to feel sad or anxious predicts depressive symptoms from one day to another in a group of individuals with elevated depression scores.
  • These theories advocate to abandon the use of sumscores in depression research and either wish to focus on (a) different MDD symptoms individually or (b) to combine these in depression networks in which they explore the dynamic interrelations of different symptoms simultaneously (Cramer et al., 2010).

Participants

  • The authors employed Amazon’s Mechanical Turk services , preselecting potential participants with elevated depression scores.
  • Participants were reimbursed $1 for completing the survey each day, receiving an additional $20 at the end of the study if they had completed 25 days or more.
  • 1 Responders who agreed to participate (n = 121) did not differ from the subset of suitable participants that did not take part in their study (n = 86) in gender or age, nor in PHQ-scores or self-reported MDD diagnosis (all p’s ≥ 067).

Procedure and Measures

  • Upon giving their informed consent and completing several other self-report questionnaires in a survey prior to their daily diary study (not relevant to this report), participants received a daily e-mail with a hyperlink to a Qualtrics questionnaire.
  • E-mails were sent out each day at 7:00 PM local time and participants received instructions to complete the survey before 3:00 AM the next day.
  • Data from surveys completed after the instructed deadline were excluded from analyses.
  • The average Cronbach’s alpha across days for the daily depressive symptoms composite was .86, ranging from .80 to .89.
  • While all reported analyses are based on the 5-item version, analyses using the 4-item version yielded similar results and support the same conclusions.

Statistical analysis

  • To examine the temporal relation between perceived social pressure to avoid feeling negative and depression, the authors used vector autoregressive (VAR) models with a multilevel extension (Bringmann et al., 2013), meaning that slopes and intercept were allowed to vary across participants to account for possible interindividual differences.
  • In terms of missing data, there was no indication that the missingness was not at random (i.e. compliance was not related to person-characteristics, nor did the authors observe any time effects).
  • Next to the total depression score, the authors repeated these analyses for participants’ perceived social expectancies and each of the 11 individual depression symptoms separately.
  • Each network composed several multilevel VAR models, in which every variable once served as an outcome, regressed on its day-lagged version, as well as on the day-lagged version of each of the other dependent variables in the network.
  • For each symptom network centrality strength plots were calculated, displaying the in- and outstrength centrality of each node in the network.

Results

  • Within-person correlations obtained from multilevel analyses (see Nezlek, 2012) are presented in Table 1.
  • First, both DSM-5 core symptoms of depression, sadness and anhedonia, were positively predicted by a person’s social expectancies perceived on the previous day, but not vice versa.
  • Solid green arrows surpassed the significance threshold after applying FDR (Benjamini et al., 2006) and represent a positive relationship between two nodes.
  • These measures are based on all cross-regressive coefficients (i.e. not only the significant ones).
  • For positive somatic symptoms the only cross-regressive link that remained significant after applying FDR was hypersomnia predicting an increase in psychomotor agitation.

Discussion

  • Drawing on daily life data of a sample with elevated depression scores, the authors examined the role of perceived social pressure not to experience negative affect in the prediction of depressive symptoms.
  • The authors found converging evidence that perceived social expectancies not to feel sad or anxious do not follow from depressive symptoms, but rather themselves predict increases in depressive symptomatology.
  • This did not only apply for overall depression severity, but also for the vast majority of individual depressive symptoms.
  • Finally, exploratory centrality analyses were in line with the current findings.
  • When society pressures people to pursue the unattainable state of constant happiness, while marginalizing the natural occurrence of negative emotions like sadness and anxiety, this inevitably creates a discrepancy between people’s experienced mood and these salient reference values.

Clinical implications

  • Interventions that tackle this perceived social pressure may be implemented both on a micro and macro level, referring to the individual or broader society respectively.
  • From a micro perspective, an individual’s perception does not necessarily match objective reality (Jussim, 1991).
  • These therapeutic approaches all share their origin in Eastern Buddhist culture where a dialectic worldview is emphasized, promoting a balanced embrace of one’s emotional repertoire.
  • Finally, creating a receptive and caring social platform (e.g. in the form of therapeutic family sessions) might also be beneficial (Brown & Andrews, 1986).
  • With respect to possible interventions on a macro level, large-scale (psycho- )educational programs that destigmatize occasionally feeling sad or anxious and tackle people’s prejudice towards mood disorders, are likely to be essential in gradually shifting society’s conception of negative emotion.

Limitations

  • Several limitations are noteworthy to their study.
  • Direct causal claims about this relationship cannot be made.
  • As the current design is correlational, the apparent relationship between this social pressure and depression may be explained by other unobserved variables.
  • Finally, it is currently unclear to what degree the current findings are specific to depression.
  • In conclusion, their findings indicate that experiencing pressure not to feel negative emotions, paradoxically predicts an increase in depressive symptoms over time.

Did you find this useful? Give us your feedback

Content maybe subject to copyright    Report

DEJONCKHEERE social pressure not to feel bad in depression 1
Paper accepted at Depression & Anxiety. Cite As:
Dejonckheere, E., Bastian, B., Fried, I. E., Murphy, S., & Kuppens, P. (2017). Perceiving social
pressure not to feel negative predicts depressive symptoms in daily life. Depression & Anxiety,
DOI: 10.1002/da.22653
Perceiving social pressure not to feel negative predicts depressive symptoms in daily life
Egon Dejonckheere
1
, Brock Bastian
2
, Eiko I. Fried
3
, Sean Murphy
2
& Peter Kuppens
1
1
KU Leuven Department of Psychology
2
University of New South Wales / University of Melbourne School of Psychology
3
University of Amsterdam Department of Psychology
Correspondence concerning this article should be addressed to Egon
Dejonckheere, Department of Psychology, KU Leuven, Tiensestraat
102, 3000 Leuven, Belgium. E-mail: egon.dejonckheere@kuleuven.be
Telephone: +32 16 37 42 46. Fax: +32 16 32 59 93.

DEJONCKHEERE social pressure not to feel bad in depression 2
Abstract
Background Western societies often overemphasize the pursuit of happiness, and regard
negative feelings like sadness or anxiety as maladaptive and unwanted. Despite this emphasis
on happiness, the amount of people suffering from depressive complaints is remarkably high.
To explain this apparent paradox, we examined whether experiencing social pressure not to feel
sad or anxious could in fact contribute to depressive symptoms.
Methods A sample of individuals (n = 112) with elevated depression scores (PHQ-9 10)
took part in an online daily diary study in which they rated their depressive symptoms and
perceived social pressure not to feel depressed or anxious for 30 consecutive days. Using
multilevel VAR models we investigated the temporal relation between this perceived social
pressure and depressive symptoms in order to determine directionality.
Results Primary analyses consistently indicated that experiencing social pressure predicts
increases in both overall severity scores and most individual symptoms of depression, but not
vice versa. A set of secondary analyses, in which we adopted a network perspective on
depression, confirmed these findings. Using this approach, centrality analysis revealed that
perceived social pressure not to feel negative plays an instigating role in depression, reflected
by the high out- and low instrength centrality of this pressure in the various depression
networks.
Conclusions Together, these findings indicate how perceived societal norms may contribute
to depression, hinting at a possible malignant consequence of society’s denouncement of
negative emotions. Clinical implications are discussed.
Keywords: depression, anxiety, emotions, culture, social norm

DEJONCKHEERE social pressure not to feel bad in depression 3
Introduction
Prevalence rates of Major Depressive Disorder (MDD) in Western societies are remarkably
high. With epidemiological estimates having doubled in the last 3 decades (Compton et al.,
2006), today one in six Americans will suffer from depression at some point in their lives
(Kessler et al., 2012), making it a leading cause of disability in modern ‘first-world’ societies
(Ferrari et al., 2013). Beside the emotional and psychological distress for patients and their
immediate social environment (e.g. reduced quality of life, social dysfunction; Lépine & Briley,
2011), MDD leaves the broader society with an extensive economic burden (Greenberg et al.,
2015), pushing researchers to discover the mechanisms underlying this debilitating disorder.
At the same time and almost paradoxically society seems to be exceedingly
preoccupied with happiness (Bastian et al., 2012; Sheldon & Lyubomirsky, 2006). Particularly
in Western countries where MDD prevalence rates are especially high (e.g. Weissman et al.,
1996), today’s societal norm encourages people to pursue happiness (Bastian et al., 2012;
2015a), ranging from brand commercials emphasizing the hedonic pleasure of consumption
(e.g. Lewis & Hill, 1998), to national indexes carefully monitoring citizen’s well-being and life
satisfaction (e.g. Diener, 2000). Simultaneously, negative emotions like sadness and anxiety
commonly receive a maladaptive and dysfunctional connotation (Haslam, 2005), with the
adaptive nature of feeling negative at times, such as regulating social interaction (Fischer &
Manstead, 2008; McNulty, 2010) and contributing to a meaningful life (Hayes et al., 1999),
hardly being mentioned in modern societal discourse (Bastian et al., 2012).
Although emphasizing happiness might seem laudable for people’s well-being, recent
studies also point to detrimental consequences of the pressure to feel happy and not sad. Lab
results indicate that participants who are experimentally induced to value happiness react less

DEJONCKHEERE social pressure not to feel bad in depression 4
positively to happy emotion induction (Mauss et al., 2011). Conversely, perceiving societal
pressure not to experience or express negative emotions is associated with higher levels of
negative affect and reduced well-being, a finding that was found to be particularly strong in
Western societies (Bastian et al., 2012). Such perceived pressure has moreover been related to
loneliness (Bastian et al., 2015a) and to biased attention for negative information (Bastian et
al., 2015b). The underlying idea is that perceiving high pressure not to experience negative
emotion creates a discrepancy between one’s actual emotional state and the social standard
deemed desirable when an individual inevitably feels sad or anxious, leading to negative self-
reflections and an ironic amplification of these unwanted emotions (e.g. Carver & Scheier,
1990; Nolen-hoeksema, 1991).
Could it be that the high premium society places on happiness may paradoxically
contribute to the prevalence of depression and its symptoms? Preliminary experimental
evidence shows that communicating that public opinion disapproves of the experience of
negative emotions leads to a temporary augmentation of negative affect (Bastian et al., 2012).
Yet whether these social expectancies play a role in depressive symptoms in the complexity of
everyday life remains unexplored.
In the present study, we sought to examine the role of the perceived pressure not to
experience negative emotions in the occurrence of depressive symptoms in real life. In
particular, we examined whether the perceived pressure not to feel sad or anxious predicts
depressive symptoms from one day to another in a group of individuals with elevated depression
scores. Participants who exhibited depressive complaints were preselected from a larger initial
pool. They next participated in a daily diary study in which they reported their depressive

DEJONCKHEERE social pressure not to feel bad in depression 5
symptoms and perceived social expectancies not to feel depressed or anxious on a daily basis
for 30 consecutive days.
In addition to an overall depression score, we also investigated whether this perceived
pressure predicted the presence of individual depression symptoms. Contemporary theories on
psychopathology (Cramer et al., 2010; Fried, 2015; Fried & Nesse, 2015) no longer
conceptualize MDD as a homogeneous, demarcated condition, composed by a variety of
interchangeable symptoms (e.g. suicidal ideation vs. appetite gain), but rather understand
depression as a dynamic system of interacting symptoms, acknowledging the fact that different
depressive symptoms may have different risk factors (e.g. Rottenberg et al., 2007; Strange et
al., 2016), temporal trajectories (e.g. Iacoviello et al., 2010) or consequences (e.g. Fried &
Nesse, 2015). In this respect, these theories advocate to abandon the use of (unweighted) sum-
scores in depression research and either wish to focus on (a) different MDD symptoms
individually or (b) to combine these in depression networks in which they explore the dynamic
interrelations of different symptoms simultaneously (Cramer et al., 2010). The present paper
thus investigates both the more traditional sum-score and, additionally, takes on a more
symptom-based focus in line with the network perspective on psychopathology.
Materials and Method
Participants
We employed Amazon’s Mechanical Turk services (MTurk), preselecting potential participants
with elevated depression scores. Recent studies investigating characteristics of MTurk samples
illustrated that the MTurk community endorses depression and anxiety symptoms to a
substantially larger degree than nonclinical samples (Arditte et al., 2015), while resembling the
general population in other demographic aspects more closely than traditional convenience

Citations
More filters
Journal ArticleDOI
TL;DR: Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.

297 citations

Journal ArticleDOI
TL;DR: A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms.
Abstract: Background: Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility. Methods: Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of "network analysis" with the terms "anxiety," "affective disorders," "depression," "schizophrenia," "psychosis," "personality disorders," "substance abuse" and "psychopathology." Results: The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence. Conclusions: A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

181 citations

Journal ArticleDOI
TL;DR: Analysis of affective time series data shows that conventional emotion research is currently unable to demonstrate independent relations between affect dynamics and psychological well-being, and dynamic measures used to capture emotional change add little to the information conveyed by mean affect and its variance.
Abstract: Over the years, many studies have demonstrated a relation between emotion dynamics and psychological well-being1. Because our emotional life is inherently time-dynamic2–6, affective scientists argue that, next to how positive or negative we feel on average, patterns of emotional change are informative for mental health7–10. This growing interest initiated a surge in new affect dynamic measures, each claiming to capture a unique dynamical aspect of our emotional life, crucial for understanding well-being. Although this accumulation suggests scientific progress, researchers have not always evaluated (a) how different affect dynamic measures empirically interrelate and (b) what their added value is in the prediction of psychological well-being. Here, we address these questions by analysing affective time series data from 15 studies (n = 1,777). We show that (a) considerable interdependencies between measures exist, suggesting that single dynamics often do not convey unique information, and (b) dynamic measures have little added value over mean levels of positive and negative affect (and variance in these affective states) when predicting individual differences in three indicators of well-being (life satisfaction, depressive symptoms and borderline symptoms). Our findings indicate that conventional emotion research is currently unable to demonstrate independent relations between affect dynamics and psychological well-being. Research into emotion dynamics and well-being has, over the years, used an increasing number of dynamic measures to capture emotional change. Dejonckheere et al. show that these measures add little to the information conveyed by mean affect and its variance.

166 citations

Journal ArticleDOI
TL;DR: In this paper, the authors used multilevel vector autoregressive time-series models to estimate between-subjects associations among these variables and found that more time spent on PSMU was associated with higher levels of interest loss, concentration problems, fatigue, and loneliness.
Abstract: Passive social media use (PSMU)—for example, scrolling through social media news feeds—has been associated with depression symptoms. It is unclear, however, if PSMU causes depression symptoms or vice versa. In this study, 125 students reported PSMU, depression symptoms, and stress 7 times daily for 14 days. We used multilevel vector autoregressive time-series models to estimate (a) contemporaneous, (b) temporal, and (c) between-subjects associations among these variables. (a) More time spent on PSMU was associated with higher levels of interest loss, concentration problems, fatigue, and loneliness. (b) Fatigue and loneliness predicted PSMU across time, but PSMU predicted neither depression symptoms nor stress. (c) Mean PSMU levels were positively correlated with several depression symptoms (e.g., depressed mood and feeling inferior), but these associations disappeared when controlling for all other variables. Altogether, we identified complex relations between PSMU and specific depression symptoms that warrant further research into potentially causal relationships.

160 citations


Cites methods from "Perceiving social pressure not to f..."

  • ...Notably, the sample size is larger than many recently published studies using the same methodology (e.g., DeJonckheere et al., 2017; Pe et al., 2015)....

    [...]

Journal ArticleDOI
TL;DR: Evidence is reviewed for how cultural differences in Asian cultures think differently about emotion than do Western cultures and that these different systems of thought help explain why negative affect does not escalate into clinical disorder at the same rate.
Abstract: Lifetime rates of clinical depression and anxiety in the West tend to be approximately 4 to 10 times greater than rates in Asia. In this review, we explore one possible reason for this cross-cultural difference, that Asian cultures think differently about emotion than do Western cultures and that these different systems of thought help explain why negative affect does not escalate into clinical disorder at the same rate. We review research from multiple disciplines-including cross-cultural psychology, social cognition, clinical psychology, and psychiatry-to make the case that the Eastern holistic principles of contradiction (each experience is associated with its opposite), change (the world exists in a state of constant flux), and context (the interconnectedness of all things) fundamentally shape people's experience of emotions in different cultures. We then review evidence for how these cultural differences influence how successfully people use common emotion regulation strategies such as rumination and suppression.

96 citations

References
More filters
Journal ArticleDOI
TL;DR: In this paper, a different approach to problems of multiple significance testing is presented, which calls for controlling the expected proportion of falsely rejected hypotheses -the false discovery rate, which is equivalent to the FWER when all hypotheses are true but is smaller otherwise.
Abstract: SUMMARY The common approach to the multiplicity problem calls for controlling the familywise error rate (FWER). This approach, though, has faults, and we point out a few. A different approach to problems of multiple significance testing is presented. It calls for controlling the expected proportion of falsely rejected hypotheses -the false discovery rate. This error rate is equivalent to the FWER when all hypotheses are true but is smaller otherwise. Therefore, in problems where the control of the false discovery rate rather than that of the FWER is desired, there is potential for a gain in power. A simple sequential Bonferronitype procedure is proved to control the false discovery rate for independent test statistics, and a simulation study shows that the gain in power is substantial. The use of the new procedure and the appropriateness of the criterion are illustrated with examples.

83,420 citations


"Perceiving social pressure not to f..." refers methods in this paper

  • ...To reduce the occurrence of TypeI errors, we controlled for multiple testing (n = 11) using a false discovery rate (FDR) procedure as proposed by Benjamini and Hochberg (1995)....

    [...]

Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations

Journal ArticleDOI
TL;DR: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity, which makes it a useful clinical and research tool.
Abstract: OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.

26,004 citations

Journal ArticleDOI
TL;DR: studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action are reviewed.
Abstract: studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.

5,891 citations


"Perceiving social pressure not to f..." refers background in this paper

  • ...…wave cognitive behavioral psychotherapies (e.g., dialectical behavioral therapy, Linehan, 2014; acceptance and commitment therapy, Hayes et al., 1999; mindfulnessbased cognitive therapy, Kabat-Zinn, 2003), which are known to be effective in treating depression (Kahl, Winter, & Schweiger, 2012)....

    [...]

Journal ArticleDOI
TL;DR: Representative selection of respondents, naturalistic experience sampling measures, and other methodological refinements are now used to study subjective well-being and could be used to produce national indicators of happiness.
Abstract: One area of positive psychology analyzes subjective well-being (SWB), people's cognitive and affective evaluations of their lives. Progress has been made in understanding the components of SWB, the importance of adaptation and goals to feelings of well-being, the temperament underpinnings of SWB, and the cultural influences on well-being. Representative selection of respondents, naturalistic experience sampling measures, and other methodological refinements are now used to study SWB and could be used to produce national indicators of happiness.

5,508 citations


"Perceiving social pressure not to f..." refers background in this paper

  • ...…people to pursue happiness (Bastian et al., 2012; Bastian, Koval et al., 2015), ranging from brand commercials emphasizing the hedonic pleasure of consumption (e.g., Lewis, & Hill, 1998) to national indexes carefully monitoring citizen’s well-being and life satisfaction (e.g., Diener, 2000)....

    [...]

Frequently Asked Questions (1)
Q1. What have the authors contributed in "Perceiving social pressure not to feel negative predicts depressive symptoms in daily life" ?

To explain this apparent paradox, the authors examined whether experiencing social pressure not to feel sad or anxious could in fact contribute to depressive symptoms. Methods – A sample of individuals ( n = 112 ) with elevated depression scores ( PHQ-9 ≥ 10 ) took part in an online daily diary study in which they rated their depressive symptoms and perceived social pressure not to feel depressed or anxious for 30 consecutive days. Using multilevel VAR models the authors investigated the temporal relation between this perceived social pressure and depressive symptoms in order to determine directionality. Using this approach, centrality analysis revealed that perceived social pressure not to feel negative plays an instigating role in depression, reflected by the high outand low instrength centrality of this pressure in the various depression networks. Clinical implications are discussed.