Affect regulation and depression

Here, I am discussing two articles on affect regulation. First, Everaert, Benisty, Gadassi Polack, Joormann & Mishne (2022) published “Which Features of Repetitive Negative Thinking and Positive Reappraisal Predict Depression? An in-depth investigation using artificial neural networks with feature selection” in Journal of Psychopathology and Clinical Science. Here’s the edited abstract with some information in bold:

Emotion regulation habits have long been implicated in risk for depression. However, research in this area traditionally adopts an approach that ignores the multifaceted nature of emotion regulation strategies, the clinical heterogeneity of depression, and potential differential relations between emotion regulation features and individual symptoms. To address limitations associated with the dominant aggregate-level approach, this study aimed to identify which features of key emotion regulation strategies are most predictive and when those features are most predictive of individual symptoms of depression across different time lags. Leveraging novel developments in the field of machine learning, artificial neural network models with feature selection were estimated using data from 460 participants who participated in a 20-wave longitudinal study with weekly assessments. At each wave, participants completed measures of repetitive negative thinking, positive reappraisal, perceived stress, and depression symptoms. Results revealed that specific features of repetitive negative thinking (wondering “why cannot I get going?” and having thoughts or images about feelings of loneliness) and positive reappraisal (looking for positive sides) were important indicators for detecting various depressive symptoms, above and beyond perceived stress. These features had overlapping and unique predictive relations with individual cognitive, affective, and somatic symptoms. Examining temporal fluctuations in the predictive utility, results showed that the utility of these emotion regulation features was stable over time. These findings illuminate potential pathways through which emotion regulation features may confer risk for depression and help to identify actionable targets for its prevention and treatment. 

I like this study because it suggests that the effects of negative thinking and positive reappraisal are at least as important as perceived stress in predicting depression. The second article makes an equally important assertion. Coppersmith et al. (2023) published ”Suicidal Thinking as Affect Regulation” in Journal of Psychopathology and Clinical Science.  Here are edited versions of the abstract and impact statement again with some information in bold:

Suicidal thinking persists over time for many people. Nine percent of people worldwide report thinking about suicide at some point during their lives. A fundamental question we currently lack a clear answer to is: why do suicidal thoughts persist over time? One possibility is that suicidal thoughts serve adaptive functions for people who experience them. We tested whether suicidal thinking may serve as a form of affect regulation. In a real-time monitoring study among adults with recent suicidal thoughts (N = 105), we found that participants often endorsed using suicidal thinking as a form of affect regulation. The occurrence of suicidal thinking was followed by decreased negative affect. However, when assessing the direction of the relationship between suicidal thinking and negative affect, we also found positive bidirectional associations between them. Finally, using suicidal thinking as a form of affect regulation predicted the frequency and severity of suicidal thinking at later time points. This study suggests that suicidal thoughts may persist because people use them to decrease negative affect. Specifically, people endorsed using suicidal thoughts to regulate negative affect, which in turn, predicted more frequent and severe suicidal thoughts. 

I find it quite fascinating that, when people have suicidal thoughts, their negative affect declines even though negative affect can also increase suicidal ideation. It makes sense to me that repetitive negative thinking becomes rumination in ways that can easily lead to depression. A “why don’t I just kill myself?” can be seen as a kind of hope – “if I kill myself, I will no longer have to deal with these feelings.” The fact that both studies find predictive power in focusing on affect regulation may be important to clinicians dealing with depressed clients.