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Emotion-modulated startle in anxiety disorders is blunted by co-morbid depressive episodes

Published online by Cambridge University Press:  16 March 2010

A. Taylor-Clift ,
B. H. Morris ,
J. Rottenberg  and
M. Kovacs
A. Taylor-Clift
Affiliation:
Department of Psychology, University of South Florida, Tampa, FL, USA
B. H. Morris
Affiliation:
Department of Psychology, University of South Florida, Tampa, FL, USA
J. Rottenberg*
Affiliation:
Department of Psychology, University of South Florida, Tampa, FL, USA
M. Kovacs
Affiliation:
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
*
*Address for correspondence: J. Rottenberg, PhD, University of South Florida, 4202 E. Fowler Ave., PCD 4118G, Tampa, FL 33624, USA. (Email: jrottenb@cas.usf.edu)
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Abstract

Background

While anxiety has been associated with exaggerated emotional reactivity, depression has been associated with blunted, or context insensitive, emotional responding. Although anxiety and depressive disorders are frequently co-morbid, surprisingly little is known about emotional reactivity when the two disorders co-occur.

Method

We utilized the emotion-modulated startle (EMS) paradigm to examine the effects of a concurrent depressive episode on emotional reactivity in young adults with anxiety disorders. Using an archival dataset from a multi-disciplinary project on risk factors in childhood-onset depression, we examined eye-blink startle reactions to late-onset auditory startle probes while participants viewed pictures with affectively pleasant, unpleasant and neutral content. EMS response patterns were analyzed in 33 individuals with a current anxiety (but no depressive) disorder, 24 individuals with a current anxiety disorder and co-morbid depressive episode and 96 healthy controls.

Results

Control participants and those with a current anxiety disorder (but no depression) displayed normative linearity in startle responses, including potentiation by unpleasant pictures. By contrast, individuals with concurrent anxiety and depression displayed blunted EMS.

Conclusions

An anxiety disorder concurrent with a depressive episode is associated with reactivity that more closely resembles the pattern of emotional responding that is typical of depression (i.e. context insensitive) rather than the pattern that is typical for anxiety (i.e. exaggerated).

Keywords

Anxietyco-morbiditydepressionemotionstartle
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 129 - 139
Copyright
Copyright © Cambridge University Press 2010

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References

Allen, NB, Trinder, J, Brennan, C (1999). Affective startle modulation in clinical depression: preliminary findings. Biological Psychiatry 46, 542–550.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders (fourth edn). American Psychiatric Association: Washington.Google Scholar
Barlow, DH, Craske, MG, Cerny, JA, Klosko, J (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20, 1–26.CrossRefGoogle Scholar
Bradley, BP, Mogg, K, Millar, N, White, J (1995). Selective processing of negative information: effects of clinical anxiety, concurrent depression, and awareness. Journal of Abnormal Psychology 104, 532–536.CrossRefGoogle ScholarPubMed
Bradley, MM, Cuthbert, BN, Lang, PJ (1990). Startle reflex modification: emotion or attention? Psychophysiology 27, 513–522.CrossRefGoogle ScholarPubMed
Bradley, MM, Lang, PJ (1994). Measuring emotion: the self-assessment manikin and the semantic differential. Journal of Behavior Therapy & Experimental Psychiatry 25, 49–59.CrossRefGoogle ScholarPubMed
Bradley, MM, Lang, PJ (2000). Affective reactions to acoustic stimuli. Psychophysiology 37, 204–215.CrossRefGoogle ScholarPubMed
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB (2001). Current and lifetime co-morbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585–599.CrossRefGoogle Scholar
Bruce, SE, Machan, JT, Dyck, I, Keller, MB (2001). Infrequency of ‘Pure’ GAD: impact of psychiatric comorbidity on clinical course. Depression and Anxiety 14, 219–225.CrossRefGoogle ScholarPubMed
Buhlmann, U, Wilhelm, S, Deckersbach, T, Rauch, SL, Pitman, RK, Orr, SP (2007). Physiologic responses to loud tones in individuals with obsessive compulsive disorder. Psychosomatic Medicine 69, 166–172.CrossRefGoogle ScholarPubMed
Bylsma, LM, Morris, B, Rottenberg, J (2008). A meta-analysis of emotional reactivity in major depressive disorder. Clinical Psychology Review 28, 676–691.CrossRefGoogle ScholarPubMed
Cuthbert, BN, Lang, PJ, Strauss, C (2003). The psychophysiology of anxiety disorder: fear memory imagery. Psychophysiology 40, 407–422.CrossRefGoogle ScholarPubMed
Davis, M (1989). Neural systems involved in fear-potentiated startle. Annals of the New York Academy of Sciences 563, 165–183.CrossRefGoogle ScholarPubMed
Davis, M, Gendelman, DS, Tischler, MD, Gendelman, PM (1982). A primary acoustic startle circuit: lesion and stimulation studies. Journal of Neuroscience 6, 791–805.CrossRefGoogle Scholar
Dichter, GS, Tomarken, AJ (2008). The chronometry of affective startle modulation in unipolar depression. Journal of Abnormal Psychology 117, 1–15.CrossRefGoogle ScholarPubMed
Dichter, GS, Tomarken, AJ, Shelton, RC, Sutton, SK (2004). Early- and late-onset startle modulation in unipolar depression. Psychophysiology 41, 433–440.CrossRefGoogle ScholarPubMed
Elsesser, K, Sartory, G, Tackenberg, A (2004). Attention, heart rate, and startle response during exposure to trauma-relevant pictures: a comparison of recent trauma victims and patients with posttraumatic stress disorder. Journal of Abnormal Psychology 113, 289–301.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition with Psychotic Screen (SCID-I/P W/ PSY SCREEN). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Forbes, EE, Miller, A, Cohn, JF, Fox, NA, Kovacs, M (2005). Affect-modulated startle in adults with childhood-onset depression: relations to bipolar course and number of lifetime depressive episodes. Psychiatric Research 134, 11–25.CrossRefGoogle ScholarPubMed
Fridlund, AJ, Cacioppo, JT (1986). Guidlines for electromyographic research. Psychophysiology 23, 567–589.CrossRefGoogle Scholar
Gaynes, BN, Magruder, KM, Burns, BJ, Wagner, R, Yarnall, KSH, Broadhead, WE (1999). Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? General Hospital Psychiatry 21, 158–167.CrossRefGoogle ScholarPubMed
Griffin, MG (2008). A prospective assessment of auditory startle alterations in rape and physical assault survivors. Journal of Traumatic Stress 21, 91–99.CrossRefGoogle ScholarPubMed
Grillon, C, Ameli, R, Goddard, A, Woods, SW, Davis, M (1994). Baseline and fear-potentiated startle in panic disorder patients. Biological Psychiatry 35, 431–439.CrossRefGoogle ScholarPubMed
Grillon, C, Dierker, L, Merikangas, KR (1998). Fear-potentiated startle in adolescent offspring of parents with anxiety disorders. Biological Psychiatry 44, 990–997.CrossRefGoogle ScholarPubMed
Hazlett, EA, Dawson, ME, Schell, AM, Nuechterlein, KH (2007). Probing attentional dysfunctions in schizophrenia: startle modification during a continuous performance test. Psychophysiology 45, 632–642.CrossRefGoogle Scholar
Herpertz, SC, Kunert, HJ, Schwenger, UB, Sass, H (1999). Affective responsiveness in borderline personality disorder: a psychophysiological approach. American Journal of Psychiatry 156, 1550–1556.CrossRefGoogle ScholarPubMed
Huynh, H, Feldt, LS (1976). Estimation of the box correction for degrees of freedom from sample data in randomized block and split-plot designs. Journal of Educational Statistics 1, 69–82.CrossRefGoogle Scholar
Jankel, C, Keener-Miller, AD, Cohn, JC, Monaco, V (1999). Affective startle modulation: psychometric comparison of alternative electrode placements and computational algorithms. Psychophysiology 36, S63.Google Scholar
Judd, LL, Akiskal, HS, Maser, JD, Zeller, PJ, Endicott, J, Coryell, W, Paulus, MP, Kunovac, JL, Leon, AC, Mueller, TI, Rice, JA, Keller, MB (1998 a). Special issue: George Winokur. Journal of Affective Disorders 50, 97–108.CrossRefGoogle Scholar
Judd, LL, Kessler, RC, Paulus, MP, Zeller, PJ, Wittchen, HU, Kunovac, JL (1998 b). Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatrica Scandinavica 98, 6–11.CrossRefGoogle Scholar
Kaplan, JS, Erickson, K, Luckenbaugh, DA, Weiland-Fiedler, P, Geraci, M, Sahakian, BJ, Charney, D, Drevets, WC, Neumeister, A (2006). Differential performance on tasks of affective processing and decision-making in patients with panic disorder and panic disorder with co-morbid major depressive disorder. Journal of Affective Disorders 95, 165–171.CrossRefGoogle Scholar
Kaviani, H, Gray, JA, Checkley, SA, Wilson, GD, Kumari, V (2004). Affective modulation of the startle response in depression, anhedonia, and anxiety. Journal of Affective Disorders 83, 21–31.CrossRefGoogle ScholarPubMed
Kessler, RC, DuPont, RL, Berglund, P, Wittchen, HU (1999). Impairment in pure and co-morbid generalized anxiety disorder and major depression: 12 months in two national surveys. American Journal of Psychiatry 156, 1915–1923.CrossRefGoogle Scholar
Koch, M, Schnitzler, HU (1997). The acoustic startle response in rats – circuits mediating evocation, inhibition, and potentiation. Behavioural Brain Research 89, 35–49.CrossRefGoogle ScholarPubMed
Kovacs, M (1996). Presentation and course of major depressive disorder during childhood and later years of the life span. Journal of the American Academy of Child & Adolescent Psychiatry 35, 705–715.CrossRefGoogle ScholarPubMed
Kovacs, M, Feinberg, TL, Crouse-Novak, MA, Paulauskas, SL, Finkelstein, R (1984 a). Depressive disorders in childhood. I. A longitudinal prospective study of characteristics and recovery. Archives of General Psychiatry 41, 229–237.CrossRefGoogle Scholar
Kovacs, M, Feinberg, TL, Crouse-Novak, MA, Paulauskas, SL, Pollock, M, Finkelstein, R (1984 b). Depressive disorders in childhood. II. A longitudinal study of the risk for a subsequent major depression. Archives of General Psychiatry 41, 643–649.CrossRefGoogle Scholar
Kumari, V, Kaviani, H, Raven, PW, Gray, JA, Checkley, SA (2001). Enhanced startle reactions to acoustic stimuli in patients with obsessive-compulsive disorder. American Journal of Psychiatry 158, 134–136.CrossRefGoogle ScholarPubMed
Ladouceur, CD, Dahl, RE, Williamson, DE, Birmaher, B, Ryan, ND, Casey, BJ (2005). Altered emotional processing in pediatric anxiety, depression, and comorbid anxiety-depression. Journal of Abnormal Child Psychology 33, 165–177.CrossRefGoogle ScholarPubMed
Landis, C, Hunt, WA (1939). The Startle Pattern. Farrar and Company, Inc: New York.Google Scholar
Lang, PJ, Bradley, MM, Cuthbert, BN (1990). Emotion, attention, and the startle reflex. Psychological Review 97, 377–395.CrossRefGoogle ScholarPubMed
Lang, PJ, Bradley, MM, Cuthbert, BN (1999). International Affective Picture System (IAPS): Technical Manual and Affective Ratings. Center for Research in Psychophysiology: University of Florida, Gainsville.Google Scholar
Lang, PJ, Bradley, MM, Cuthbert, BN (2005 a). International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual. University of Florida: Gainsville, FL.Google Scholar
Lang, PJ, McTeague, LM, Cuthbert, BN (2005 b). Fearful imagery and the anxiety disorder spectrum. In Pathological Anxiety: Emotional Processing in Etiology and Treatment (ed. Rothbaum, B.). Guilford Press: New York.Google Scholar
Lang, PJ, McTeague, LM, Cuthbert, BN (2007). Fear, anxiety, depression, and the anxiety disorder spectrum: a psychophysiological analysis. In Psychological Clinical Science: Papers in Honor of Richard M. McFall (ed. Treat, T. A., Bootzin, R. R. and Baker, T. B.). Psychology Press: New York, NY.Google Scholar
Larsen, DK, Norton, GR, Walker, JR (2002). Analysis of startle responses in patients with panic disorder and social phobia. Cognitive Behaviour Therapy 31, 156–169.CrossRefGoogle Scholar
Larson, CL, Nitschke, JB, Davidson, RJ (2007). Common and distinct patterns of affective response in dimensions of anxiety and depression. Emotion 7, 182–191.CrossRefGoogle ScholarPubMed
Larson, CL, Ruffalo, D, Nietert, JY, Davidson, RJ (2000). Temporal stability of the emotion-modulated startle response. Psychophysiology 37, 92–101.CrossRefGoogle ScholarPubMed
Lewinsohn, P, Steinmetz, J, Larson, D, Franklin, J (1981). Depression related cognitions: antecedents or consequences? Journal of Abnormal Psychology 90, 213–219.CrossRefGoogle ScholarPubMed
Lipschitz, DS, Mayes, LM, Rasmusson, AM, Anyan, W, Billingslea, E, Gueorguieva, R, Southwick, SM (2005). Baseline and modulated acoustic startle responses in adolescent girls with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry 44, 807–814.CrossRefGoogle ScholarPubMed
McTeague, LM, Lang, PJ, Laplante, MC, Cutherbert, BN, Strauss, CC, Bradley, MM (2009). Fearful imagery in social phobia: generalization, co-morbidity, and physiological reactivity. Biological Psychiatry 65, 374–382.CrossRefGoogle ScholarPubMed
Merikangas, KR, Zhang, H, Avenevoli, S, Acharyya, S, Neuenschwander, M, Angst, J (2003). Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich cohort study. Archives of General Psychiatry 60, 993–1000.CrossRefGoogle Scholar
Melzig, CA, Weike, AI, Zimmermann, J, Hamm, AO (2007). Startle reflex modulation and autonomic responding during anxious apprehension in panic disorder patients. Psychophysiology 44, 846–854.CrossRefGoogle ScholarPubMed
Miller, A, Fox, N, Cohn, J, Forbes, E, Sherill, J, Kovacs, M (2002). Regional patterns of brain activity in adults with a history of childhood-onset depression: gender differences and clinical variability. American Journal of Psychiatry 159, 934–940.CrossRefGoogle ScholarPubMed
Mneimne, M, McDermut, W, Powers, AS (2008). Affective ratings and startle modulation in people with nonclinical depression. Emotion 8, 552–559.CrossRefGoogle ScholarPubMed
Morgan, CA, Grillon, C, Southwick, SM, Charney, DS (1996). Exaggerated acoustic startle reflex in Gulf War veterans with posttraumatic stress disorder. American Journal of Psychiatry 153, 64–68.Google ScholarPubMed
Patrick, CJ, Bradley, MM, Lang, PJ (1993). Emotion in the criminal psychopath: startle reflex modulation. Journal of Abnormal Psychology 102, 82–92.CrossRefGoogle ScholarPubMed
Perez-Edgar, K, Fox, N, Cohn, J, Kovacs, M (2006). Behavioral and electrophysiological markers of selective attention in children of parents with a history of depression. Biological Psychiatry 60, 1131–1138.CrossRefGoogle ScholarPubMed
Pissiota, A, Frans, Ö, Michelgård, Å, Appel, L, Långström, B, Flaten, MA, Fredrikson, M (2003). Amygdala and anterior cingulate cortex activation during affective startle modulation: a PET study of fear. European Journal of Neuroscience 18, 1325–1331.CrossRefGoogle ScholarPubMed
Putnam, KM, Silk, KR (2005). Emotion dysregulation and the development of borderline personality disorder. Development and Psychopathology 17, 899–925.CrossRefGoogle ScholarPubMed
Rosenthal, MZ, Gratz, KL, Kosson, DS, Cheavens, JS, Lejuez, CW, Lynch, TR (2008). Borderline personality disorder and emotional responding: a review of the research literature. Clinical Psychology Review 28, 75–91.CrossRefGoogle ScholarPubMed
Ross, RJ, Ball, WA, Cohen, ME, Silver, SM, Morrison, AR, Dinge, DF (1989). Habituation of the startle reflex in posttraumatic stress disorder. Journal of Neuropsychiatry & Clinical Neurosciences 1, 305–307.Google ScholarPubMed
Rottenberg, J, Gross, JJ, Gotlib, IH (2005). Emotion context insensitivity in major depression disorder. Journal of Abnormal Psychology 114, 627–639.CrossRefGoogle Scholar
Salzar, S, Pincus, AL, Hoyer, U, Kreische, R, Leichsenring, F, Leibeing, E (2008). Interpersonal subtypes within generalized anxiety disorder. Journal of Personality Assessment 90, 292–299.CrossRefGoogle Scholar
Schlenker, R, Cohen, R, Hopmann, G (1995). Affective modulation of the startle reflex in schizophrenic patients. European Archives of Psychiatry & Clinical Neuroscience 245, 309–318.CrossRefGoogle ScholarPubMed
Schmidt, LA, Fox, NA, Long, JM (1998). Brief communication: a software solution for reducing startle eyeblink responses. International Journal of Neuroscience 93, 1–6.CrossRefGoogle ScholarPubMed
Shahar, G, Scotti, MA, Rudd, MD, Joiner, TE (2008). Hypomanic symptoms predict an increase in narcissistic and histrionic personality disorder features in suicidal young adults. Depression & Anxiety 25, 892–898.CrossRefGoogle ScholarPubMed
Taiminen, T, Jaakelainen, S, Ilonen, T, Meyer, H, Karlsson, H, Lauerma, H, Leinonen, K, Wallenius, E, Kaljonen, A, Salokangas, R (2000). Habituation of the blink reflex in first episode schizophrenia, psychotic depression, and non-psychotic depression. Schizophrenia Research 44, 69–79.CrossRefGoogle ScholarPubMed
Waters, AM, Craske, M, Bergman, RL, Naliboff, BD, Negoro, H, Ornitz, EM (2008 a). Developmental changes in startle reactivity in school-age children at risk for and with actual anxiety disorder. International Journal of Psychophysiology 70, 158–164.CrossRefGoogle ScholarPubMed
Waters, AM, Neumann, DL, Henry, J, Craske, MG, Ornitz, EM (2008 b). Baseline and affective startle modulation by angry and neutral faces in 4–8-year-old anxious and non-anxious children. Biological Psychiatry 78, 10–19.CrossRefGoogle ScholarPubMed