Teenagers who can describe their negative emotions in precise and nuanced ways are better protected against depression than their peers who can’t.
That’s the conclusion of a new study about negative emotion differentiation, or NED – the ability to make fine-grained distinctions between negative emotions and apply precise labels – published in the journal Emotion.
“Adolescents who use more granular terms such as ‘I feel annoyed,’ or ‘I feel frustrated,’ or ‘I feel ashamed’ – instead of simply saying ‘I feel bad’ – are better protected against developing increased depressive symptoms after experiencing a stressful life event,” explains lead author Lisa Starr, an assistant professor of psychology at the University of Rochester.
Those who score low on negative emotion differentiation tend to describe their feelings in more general terms such as “bad” or “upset.”
As a result, they are less able to benefit from useful lessons encoded in their negative emotions, including the ability to develop coping strategies that could help them regulate how they feel.
“Emotions convey a lot of information.
They communicate information about the person’s motivational state, level of arousal, emotional valence, and appraisals of the threatening experience,” says Starr.
A person has to integrate all that information to figure out – “am I feeling irritated,” or “am I feeling angry, embarrassed, or some other emotion?”
Once you know that information you can use it to help determine the best course of action, explains Starr:
“It’s going to help me predict how my emotional experience will unfold, and how I can best regulate these emotions to make myself feel better.”
The team found that a low NED strengthens the link between stressful life events and depression, leading to reduced psychological well-being.
By focusing exclusively on adolescence, which marks a time of heightened risk for depression, the study zeroed in on a gap in the research to date.
Prior research suggests that during adolescence a person’s NED plunges to its lowest point, compared to that of younger children or adults.
It’s exactly during this developmentally crucial time that depression rates climb steadily.
Previous research had shown that depression and low NED were related to each other, but the research designs of previous studies did not test whether a low NED temporally preceded depression.
To the researchers, this phenomenon became the proverbial chicken-and-egg question: did those youth who showed signs of significant depressive symptoms have a naturally low NED, or was their NED low as a direct result of their feeling depressed?
The team, made up of Starr, Rachel Hershenberg, an assistant professor of psychiatry at Emory University, and Rochester graduate students Zoey Shaw, Irina Li, and Angela Santee, recruited 233 mid-adolescents in the greater Rochester area with an average age of nearly 16 (54 percent of them female) and conducted diagnostic interviews to evaluate the participants for depression.
Next, the teenagers reported their emotions four times daily over the period of seven days.
One and a half years later, the team conducted follow-up interviews with the original participants (of whom 193 returned) to study longitudinal outcomes.
The researchers found that youth who are poor at differentiating their negative emotions are more susceptible to depressive symptoms following stressful life events.
Conversely, those who display high NED are better at managing the emotional and behavioral aftermath of being exposed to stress, thereby reducing the likelihood of having negative emotions escalate into a clinically significant depression over time.
Depression ranks among the most challenging public health problems worldwide.
As the most prevalent mental disorder, it not only causes recurring and difficult conditions for sufferers, but also costs the U.S. economy tens of billions of dollars each year and has been identified by the World Health Organization as the number one cause of global burden among industrialized nations.
Particularly depression in adolescent girls is an important area to study, note the researchers, as this age brings a surge in depression rates, with a marked gender disparity that continues well into adulthood.
Adolescent depression disrupts social and emotional development, which can lead to a host of negative outcomes, including interpersonal problems, reduced productivity, poor physical health, and substance abuse.
Moreover, people who get depressed during adolescence are more likely to become repeatedly depressed throughout their life span, says Starr.
That’s why mapping the emotional dynamics associated with depression is key to finding effective treatments.
“Basically you need to know the way you feel, in order to change the way you feel,” says Starr.
“I believe that NED could be modifiable, and I think it’s something that could be directly addressed with treatment protocols that target NED.”
The team’s findings contribute to a growing body of research that tries to make inroads in the fight against rising rates of adolescent depression, suicidal thoughts, and suicide.
According to the most recent CDC data, about 17 percent of high school students nationwide say they have thought of suicide, more than 13 percent said they actually made a suicide plan, and 7.4 percent attempted suicide in the past year.
“Our data suggests that if you are able to increase people’s NED then you should be able to buffer them against stressful experiences and the depressogenic effect of stress,” says Starr.
The prevalence of major depression in adolescents has increased in recent years.
In the USA the prevalence increased from 8.7% in 2005 to 11.3% in 2014 (Mojtabai, Olfson, & Han, 2016) whereas in Europe, depending on the specific country, the prevalence ranged from 7.1% to 19.4% in 2012 (Balázs et al., 2013).
Major depression disorder in adolescents is characterized by constantly having a depressed and irritable mood, a diminished interest in activities, feelings of worthlessness and guilt, thought and concentration problems, and recurrent thoughts of death and suicide (Weis, 2013).
Most research into adolescent major depression focuses on intrapersonal processes, such as how processes of rumination facilitate the development of depression, or interpersonal processes, such as how social information processing, like peer rejection and victimization, enhances depression (Nolen-Hoeksema & Hilt, 2009).
However, the importance of the social discourse and sociocultural factors regarding adolescent major depression is a gap in this literature (Cicchetti & Toth, 2009).
Moreover, most research on adolescent major depression has taken the perspective of adolescents as victims of the disorder rather than human agents who construct their own lived experiences of the condition and context of major depression.
The purpose of this study was to investigate the role of social representations in adolescents’ construction of major depression in a sample of adolescents hospitalized with a major depressive disorder.
The perspective of human agency (Kuczynski, 2003) is the central concept that informed this research.
In order to define the research objectives, the following literature is reviewed: existing qualitative research into the subjectivity of adolescents with depression, Social Relational Theory (SRT) including the concept of human agency (Kuczynski & De Mol, 2015; Kuczynski & Parkin, 2006), and social representations theory (Jovchelovitch, 2001).
The research question that guided this research was: What are the social representations about being a normal person that influence depressed adolescents and their lived experiences of having a major depression?
The research objective was informed by a dominant discourse in Western society that having a psychiatric disorder, including major depressive disorder, means having an illness or pathology and not being normal (Szasz, 2011).
The word disorder exemplifies this discourse. Consequently, social representations of normality influence lived experiences of having major depression.
Current psychotherapy and clinical interventions focus on the agency of clients diagnosed with a psychiatric disorder.
Hence, psychotherapeutic and clinical implications of this research will be discussed.
Current state of the art
Most qualitative research into adolescence major depression focuses on adolescents’ perspectives about what it is like to live with a major depression and the effects on family and social life.
Adolescents with depression live constantly in a world filled with fear, associated with a fear to return to bad feelings even when the depression is under control, a fear of not being able to survive bad feelings, and a fear of not getting professional help in an efficient way (Woodgate, 2006).
These constant bad feelings also influence adolescents’ identity development (Kuwabara, Van Voorhees, Gollan, & Alexander, 2007).
Major depression seems to interrupt the development of a constructive sense of identity because these constant bad feelings do not correspond with how adolescents with depression perceive their own person.
Consequently, adolescents with depression seem to alienate from their own person.
These processes of self-alienation can also lead to social alienation (McCann, Lubman, & Clark, 2012).
Adolescent major depression has effects on family and peers.
Adolescents may perceive that their parents, siblings, and peers have difficulties understanding what it means to live with major depression and consequently are not always able to support them in a constructive way.
Social support is a very important resource for adolescents to cope with a depressed mood. In sum, qualitative research into adolescence major depression focuses only on subjective experiences and influences on family and social life.
But subjective experiences are also influenced by the social context of meanings in which the depressed adolescent is embedded. Moreover, research also indicates the influences of social factors on adolescent development (Lerner & Galambos, 1998).
A major theme in adolescent development literature regards the process of separation-individuation (Mahler, Pine, & Bergman, 1975), including identity development in the social world outside the family.
Adolescents are in a process of taking space from their own family in order to construct a social identity outside their family.
Consequently, adolescents are confronted with social complexities in their social world and these complexities also influence their identity development.
To date, there is no research that has investigated sociocultural influences on adolescence major depression. Our research focuses on the importance of the social discourse and in particular by addressing our participants, hospitalized adolescents diagnosed with a major depression, as active agents.
Perspective on agency of depressed adolescents
Social Relational Theory (SRT) (Kuczynski & De Mol, 2015; Kuczynski & Parkin, 2006) stresses the universal aspect of agency, which refers to the ontological assumption that all human beings, including adolescents with depression, are agents.
Moreover, within SRT all humans are equally agents. Agency means that each human being is considered as an actor, with the ability to make sense of the environment, initiate change, make choices, and resist demands (Kuczynski, 2003).
For analytical purposes Kuczynski (2003) partitions the concept of agency into autonomy, construction, and action.
These components of agency jointly consider the complexity of interdependent motivations, cognitions, and actions that are coordinated in a single process.
In the current research project, the focus was on the concept of construction.
Construction refers to a person’s capacity to make sense of their own behaviours, the behaviours of others and to construct new meanings from these experiences.
The process of sense making involves both cognitions and emotions.
In order to make the process of meaning construction more explicit, the concept of embodiment is of central importance. Each human is an active agent with a particular kind of lived body (Andersen, 2007; Overton, Mueller, & Newman, 2008). Embodiment refers not only to physical structures but also to the engagement of the body in the sociocultural world (Overton, 2006).
“The body as form, represents the holistic integration of the biological dimension of life, the body as lived experience actively engaged represents the integration of the psychological person, and the body actively engaged in and with the world points to the integration of the sociocultural and physical context. Thus, embodiment entails the synthesis of how we, as active agents (psychological persons), influence and are influenced by our biological and sociocultural worlds.” (Kuczynski & De Mol, 2015, p. 330)
The concept of embodiment signifies that we, as equally human agents, are being influenced through our body, and it is our body that forms the bridge between the personal, relational, and sociocultural level (Varela, Thompson, & Rosch, 2016).
However, individual differences between humans exist that affect the quality of expression and effectiveness of agency.
The process of meaning construction takes diverse forms related to specific individual resources (the particular biological body) and social resources (sociocultural context). Adolescents with depression have a particular biological body and are influenced by particular sociocultural discourses.
Consequently, these two factors influence how adolescents with depression construct meanings of their lived experiences as active agents.
Current theorizing about embodiment focuses on the interplay between embodied experience and influences of social representations (O’Connor, 2017).
In our research the concept of social representation was chosen to investigate influences of sociocultural factors on processes of meaning construction of depressed adolescents.
A social representation is the ensemble of thoughts and ideas that exists in a social community regarding a specific phenomenon (Jovchelovitch, 2001).
In other words, social representations are common thoughts or common sense knowledge co-constructed in dialogues and expressed in verbal and overt behaviour of actors within a sociocultural context. Objectification regards an important step in the construction of social representations (Wagner et al., 1999).
In social communication people develop their own interpretations of phenomena by constructing a socially shared knowledge in a specific form, that is, a metaphor or social representation that captures the complexity of the phenomenon.
This symbolic knowledge regards the creation of shared understandings as the semiotic space in which we live and is of central importance to human social life. Social representations are constructed in dialogues but it is through objectification that they become realities that exist outside of our social communication.
Consistent with social representations theory, social representations were investigated in this research by taking a realist epistemological position.
Social representations exist independently of the participants’ and researchers’ views and knowledge about it. A realist epistemological position assumes that by doing inductive research knowledge can be generated about something that exists in the real world (Willig, 2013).
In conclusion, the rationale of this study and the research question being addressed may be summarized as follows: what are important social representations about being a normal person that influence depressed adolescents’ lived experiences of being depressed.
Consistent with the concept of agency, embodiment, and social representations theory, the importance of the social discourse influencing adolescents’ lived experiences is studied.
This perspective is fully in line with current approaches in psychotherapy.
Consequently, this research may inspire psychotherapists’ clinical interventions in their daily practice.
More information: Lisa R. Starr et al, The perils of murky emotions: Emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression., Emotion (2019).DOI: 10.1037/emo0000630
Journal information: Emotion
Provided by University of Rochester