From "surviving to thriving": Mood Lifters - a wellness program for parents of medically complex children.

OBJECTIVES: Parents of medically complex children juggle unique demands associated with caring for chronically ill children, many of which negatively impact their mental wellbeing. Despite this, parents of medically complex children often forgo mental health support due to concerns with costs, time, stigma, and accessibility. There is limited research on evidence-based interventions addressing such barriers for these caregivers. We piloted an adapted version of Mood Lifters, a peer-led wellness program, to equip parents of medically complex children with evidence-based strategies to manage their mental health while also reducing barriers to support. We hypothesized parents would find Mood Lifters to be feasible and acceptable. Further, parents would experience improvements in mental wellbeing upon program completion. METHODS: We conducted a single-arm prospective pilot study to assess Mood Lifters for parents of medically complex children. Participants included 51 parents in the U.S. recruited from a local pediatric hospital providing care for their children. Caregiver mental wellbeing was assessed through validated questionnaires pre-intervention (T1) and post-intervention (T2). Repeated-measures analysis of variance was conducted to evaluate change between T1 and T2. RESULTS: Analyses from T1 and T2 (n = 18) revealed improvements in parents' depression (F(1,17) = 7.691, p = 0.013) and anxiety (F(1,17) = 6.431, p = 0.021) after program completion. Improvements in perceived stress and positive and negative emotion were significant at p < 0.0083. SIGNIFICANCE OF RESULTS: Parents of medically complex children experienced improved mental health upon participating in Mood Lifters. Results offer preliminary support for the feasibility and acceptability of Mood Lifters as an evidence-based care option that may also alleviate common barriers to care.

Adapting user-centered design principles to improve communication of peer parent narratives on pediatric tracheostomy.

BACKGROUND: Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision. METHODS: To ensure that the intervention reflects parents' needs (rather than experts' opinions), we adapted a user-centered design (UCD) process to identify decision-critical information and refine the presentation format by interviewing parents who had tracheostomy decision making experience. Phase 1 (n = 10) presented 15 possible forecasting errors and asked participants to prioritize and justify the problematic ones. It also asked participants to comment on the draft narratives and preferred delivery mode and time of the intervention. Phase 2 (n = 9 additional parents and 1 previous parent) iteratively collected feedback over four waves of user interviews to guide revisions to the informational booklet. RESULTS: Phase 1 revealed that parents wanted information to address all forecasting errors as soon as tracheostomy becomes an option. They also highlighted diverse family situations and the importance of offering management strategies. The resulting prototype booklet contained five sections: introduction, child's quality of life, home care, practical challenges, and resources. Feedback from Phase 2 focused on emphasizing individualized situations, personal choice, seriousness of the decision, and caregiver health as well as presenting concrete illustrations of future challenges with acknowledgement of positive outcomes and advice. We also learned that parents preferred to use the booklet with support from the care team rather than read it alone. CONCLUSIONS: A UCD process enabled inclusion of parental perspectives that were initially overlooked and tailoring of the intervention to meet parental expectations. Similar UCD-based approaches may be valuable in the design of other types of patient communications (e.g., decision aids).

Preliminary Evidence for Sociotropy and Autonomy in Relation to Antidepressant Treatment Outcome.

Sociotropy and autonomy are cognitive-personality styles that have been hypothesized to confer vulnerability to different presentations of major depressive disorder (MDD), which may respond differentially to treatment. Specifically, the profile of low sociotropy and high autonomy is hypothesized to indicate a positive response to antidepressant medication. The current study examines sociotropy and autonomy in relation to sertraline treatment response in individuals with MDD. As part of an ancillary study to the larger Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) project, individuals with MDD participated in an 8-week trial of sertraline and completed a self-report questionnaire of sociotropy and autonomy. Discriminant function analyses were used to examine whether sociotropy and autonomy scores could distinguish antidepressant treatment responders (determined by a 50% or greater reduction in depressive symptoms) from non-responders. The sociotropy scale successfully discriminated sertraline treatment responders from non-responders. Further, lower sociotropy was associated with greater improvements in depressive symptomology following sertraline treatment. The current findings suggest individuals with MDD characterized by low sociotropy are more likely to benefit from sertraline. Given the promising results of the Sociotropy-Autonomy Scale in discriminating treatment responders from non-responders, the low resources necessary for administration, and the ease of translation into routine clinical care, the scale warrants further research attention.

Effects of slow-wave activity on mood disturbance in major depressive disorder.

BACKGROUND: Studies have demonstrated that decreases in slow-wave activity (SWA) predict decreases in depressive symptoms in those with major depressive disorder (MDD), suggesting that there may be a link between SWA and mood. The aim of the present study was to determine if the consequent change in SWA regulation following a mild homeostatic sleep challenge would predict mood disturbance. METHODS: Thirty-seven depressed and fifty-nine healthy adults spent three consecutive nights in the sleep laboratory. On the third night, bedtime was delayed by 3 h, as this procedure has been shown to provoke SWA. The Profile of Mood States questionnaire was administered on the morning following the baseline and sleep delay nights to measure mood disturbance. RESULTS: Results revealed that following sleep delay, a lower delta sleep ratio, indicative of inadequate dissipation of SWA from the first to the second non-rapid eye movement period, predicted increased mood disturbance in only those with MDD. CONCLUSIONS: These data demonstrate that in the first half of the night, individuals with MDD who have less SWA dissipation as a consequence of impaired SWA regulation have greater mood disturbance, and may suggest that appropriate homeostatic regulation of sleep is an important factor in the disorder.

Effects of Sleep, Physical Activity, and Shift Work on Daily Mood: a Prospective Mobile Monitoring Study of Medical Interns.

BACKGROUND: Although short sleep, shift work, and physical inactivity are endemic to residency, a lack of objective, real-time information has limited our understanding of how these problems impact physician mental health. OBJECTIVE: To understand how the residency experience affects sleep, physical activity, and mood, and to understand the directional relationships among these variables. DESIGN: A prospective longitudinal study. SUBJECTS: Thirty-three first-year residents (interns) provided data from 2 months pre-internship through the first 6 months of internship. MAIN MEASURES: Objective real-time assessment of daily sleep and physical activity was assessed through accelerometry-based wearable devices. Mood scaled from 1 to 10 was recorded daily using SMS technology. Average compliance rates prior to internship for mood, sleep, and physical activity were 77.4, 80.2, and 93.7%, and were 78.8, 53.0, and 79.9% during internship. KEY RESULTS: After beginning residency, interns lost an average of 2 h and 48 min of sleep per week (t = - 3.04, p < .01). Mood and physical activity decreased by 7.5% (t = - 3.67, p < .01) and 11.5% (t = - 3.15, p < .01), respectively. A bidirectional relationship emerged between sleep and mood during internship wherein short sleep augured worse mood the next day (b = .12, p < .001), which, in turn, presaged shorter sleep the next night (b = .06, p = .03). Importantly, the effect of short sleep on mood was twice as large as mood's effect on sleep. Lastly, substantial shifts in sleep timing during internship (sleeping ≥ 3 h earlier or later than pre-internship patterns) led to shorter sleep (earlier: b = - .36, p < .01; later: b = - 1.75, p < .001) and poorer mood (earlier: b = - .41, p < .001; later: b = - .41, p < .001). CONCLUSIONS: Shift work, short sleep, and physical inactivity confer a challenging environment for physician mental health. Efforts to increase sleep opportunity through designing shift schedules to allow for adequate opportunity to resynchronize the circadian system and improving exercise compatibility of the work environment may improve mood in this depression-vulnerable population.

Eye gaze perception in bipolar disorder: Self-referential bias but intact perceptual sensitivity.

OBJECTIVES: Deficits in social cognition predict poor functional outcome in severe mental illnesses such as schizophrenia and autism. However, research findings on social cognition in bipolar disorder (BD) are sparse and inconsistent. This study aimed to characterize a critical social cognitive process-eye gaze perception-and examine its functional correlates in BD to inform psychopathological mechanisms. METHODS: Thirty participants with BD, 37 healthy controls (HC), and 46 psychiatric controls with schizophrenia (SZ) completed an eye-contact perception task. They viewed faces with varying gaze directions, head orientations, and emotion, and made eye-contact judgments. Psychophysics methods were used to estimate perception thresholds and the slope of the perception curve, which were then compared between the groups and correlated with clinical and functional measures using Bayesian inference. RESULTS: Compared with HC, patients with BD over-perceived eye contact when gaze direction was ambiguous, and this self-referential bias was similar to that in SZ. Patients with BD had lower thresholds (i.e., needed weaker eye-contact signal to start perceiving gaze as self-directed) but a similar slope compared with HC. Regression analyses showed that steeper slope predicted better socio-emotional functioning in HC and SZ, but not in BD. CONCLUSIONS: The psychopathology of social dysfunction was fundamentally different between BD and SZ in this modest sample. Eye gaze perception in BD was characterized by a self-referential bias but preserved perceptual sensitivity, the latter of which distinguished BD from SZ. The relationship between gaze perception and broader socio-emotional functioning in SZ and HC was absent in BD.

Altered N170 and mood symptoms in bipolar disorder: An electrophysiological study of configural face processing.

OBJECTIVES: Altered social behavior during mood episodes in bipolar disorder often has detrimental and long-lasting interpersonal consequences. Abnormal face processing may play a role in linking brain functions to clinical symptoms and behavior. This study aimed to understand configural face processing in bipolar disorder as a function of basic communicative attributes of the face and mood symptoms using event-related brain potentials (ERPs). METHODS: Forty-two participants with bipolar I disorder (BP) and 43 healthy controls (HC) viewed face stimuli varying in emotion (neutral or fearful), head orientation (forward or deviated), and gaze direction (direct or averted) while ERPs were recorded. Configural face processing was indexed by the N170 wave. RESULTS: BP participants had comparable overall N170 amplitude and peak latency to HC, although timing was more variable in the BP group. Abnormal N170 modulations by communicative face attributes were observed in BP: exaggerated sensitivity to emotion (fearful > neutral) in the left hemisphere, and reduced sensitivity to gaze-head incongruency (where N170 is normally larger in response to faces with incongruent than congruent gaze and head direction) in the right hemisphere. The former was not associated with mood symptoms, suggesting a heightened trait-like sensitivity to negative emotions. The latter was correlated with greater manic symptoms, indicating that an impaired perceptual sensitivity to faces with features signaling incongruent social attention may underlie social deficits observed during mania. CONCLUSIONS: These findings suggest a pathophysiological role of altered configural face processing in the phenomenology of bipolar disorder, and call for further investigations to evaluate its potential as a biomarker and treatment target.

Evaluation of Life Events in Major Depression: Assessing Negative Emotional Bias.

BACKGROUND: Overly negative appraisals of negative life events characterize depression but patterns of emotion bias associated with life events in depression are not well understood. The goal of this paper is to determine under which situations emotional responses are stronger than expected given life events and which emotions are biased. METHODS: Depressed (n = 16) and non-depressed (n = 14) participants (mean age = 41.4 years) wrote about negative life events involving their own actions and inactions, and rated the current emotion elicited by those events. They also rated emotions elicited by someone else's actions and inactions. These ratings were compared with evaluations provided by a second, 'benchmark' group of non-depressed individuals (n = 20) in order to assess the magnitude and direction of possible biased emotional reactions in the two groups. RESULTS: Participants with depression reported greater anger and disgust than expected in response to both actions and inactions, whereas they reported greater guilt, shame, sadness, responsibility and fear than expected in response to inactions. Relative to non-depressed and benchmark participants, depressed participants were overly negative in the evaluation of their own life events, but not the life events of others. CONCLUSION: A standardized method for establishing emotional bias reveals a pattern of overly negative emotion only in depressed individuals' self-evaluations, and in particular with respect to anger and disgust, lending support to claims that major depressives' evaluations represent negative emotional bias and to clinical interventions that address this bias. Copyright © 2016 John Wiley & Sons, Ltd.

Slow-wave disruption enhances the accessibility of positive memory traces.

The purpose of this study was to explore the effects of slow-wave disruption on positive and negative word recognition in a sample of healthy control participants and those with major depressive disorder. Prior to sleep, participants learned a set of emotional and neutral words during an encoding task by responding whether or not the word described them. Following baseline sleep, participants underwent one night of selective slow-wave disruption by auditory stimuli. Accuracy and reaction time to a recognition word set, including both positive and negative words, was assessed in the morning. Repeated-measures ANOVA revealed a significant interaction between word valence and condition, with positive words recognized significantly faster than negative words after disruption, in only healthy control participants. There were no significant results in those with major depressive disorder, or with regard to accuracy. These results may add to the increasing body of literature suggesting a hedonic bias to positive stimuli following sleep disruption.

Does resting-state connectivity reflect depressive rumination? A tale of two analyses.

Major Depressive Disorder (MDD) is characterized by rumination. Prior research suggests that resting-state brain activation reflects rumination when depressed individuals are not task engaged. However, no study has directly tested this. Here we investigated whether resting-state epochs differ from induced ruminative states for healthy and depressed individuals. Most previous research on resting-state networks comes from seed-based analyses with the posterior cingulate cortex (PCC). By contrast, we examined resting state connectivity by using the complete multivariate connectivity profile (i.e., connections across all brain nodes) and by comparing these results to seeded analyses. We find that unconstrained resting-state intervals differ from active rumination states in strength of connectivity and that overall connectivity was higher for healthy vs. depressed individuals. Relationships between connectivity and subjective mood (i.e., behavior) were strongly observed during induced rumination epochs. Furthermore, connectivity patterns that related to subjective mood were strikingly different for MDD and healthy control (HC) groups suggesting different mood regulation mechanisms.

Examining the effects of sleep delay on depressed males and females and healthy controls.

Individuals with major depressive disorder typically exhibit sleep electroencephalograpy abnormalities which have been shown to vary by sex. Recent research has shown that depressed males display deficits in slow wave sleep and delta electroencephalograph (EEG) activity that are not apparent in depressed females. This may suggest that males and females with depression vary with respect to their homeostatic regulation of sleep. Utilizing archival data, the present study examined the effects of a 3-h sleep delay, which represents a mild sleep challenge, on slow wave activity in healthy controls and individuals with depression. All participants slept in the laboratory for three sequential nights. On the third night in the laboratory, the participants' bedtime was delayed by 3 h. Slow wave activity was calculated utilizing power spectral analysis and compared across groups. Following the sleep delay, males with depression exhibited the lowest slow wave activity compared to all other groups. These results may suggest that males with depression are at a greater risk for homeostatic dysregulation than females, and may require specialized intervention.

Mood Lifters for Graduate Students and Young Adults: A Mixed-Methods Investigation into Mechanisms of Change in Online Group Therapy.

Mood Lifters (ML) is a dimensional, group-based, peer-led mental health program that has shown efficacy in mitigating psychopathology and promoting wellness within a variety of populations. There is not yet evidence for mechanism(s) driving these changes. Qualitative data exploring the lived experiences of participants may be a unique way to develop hypotheses about the potential mechanisms driving change. The current study used qualitative and quantitative data from the ML for Graduate Students (ML-GS) and Young Adults (ML-YA) studies to generate hypotheses regarding potential mechanisms of changes experienced in ML. Seventy-nine graduate students and fifty-nine non-student young adults provided quantitative and qualitative feedback after participating in a 12-week virtual ML program. Inductive qualitative analysis was conducted within a reflexive thematic framework. Descriptive statistics of quantitative measures were also calculated. Three themes suggest potential directions for future mechanism research on virtual ML programs. Most participants emphasized the social connections built in groups as the most potent and powerful aspects of ML, while others focused on the design or content of the program. Quantitative data presented contextualize the lived experiences of participants. Future ML research should explore the three themes identified within this study through continued qualitative and quantitative data collection and analysis. NCT05078450.

Sleep-disordered breathing in major depressive disorder.

Individuals with major depressive disorder often experience obstructive sleep apnea. However, the relationship between depression and less severe sleep-disordered breathing is unclear. This study examined the rate of sleep-disordered breathing in depression after excluding those who had clinically significant sleep apnea (>5 apneas∙h⁻¹). Archival data collected between 1991 and 2005 were used to assess the prevalence of sleep-disordered breathing events in 60 (31 depressed; 29 healthy controls) unmedicated participants. Respiratory events were automatically detected using a program developed in-house measuring thermal nasal air-flow and chest pressure. Results show that even after excluding participants with clinically significant sleep-disordered breathing, individuals with depression continue to exhibit higher rates of sleep-disordered breathing compared with healthy controls (depressed group: apnea-hypopnea index mean = 0.524, SE = 0.105; healthy group: apnea-hypopnea index mean = 0.179, SE = 0.108). Exploratory analyses were also conducted to assess for rates of exclusion in depression studies due to sleep-disordered breathing. Study exclusion of sleep-disordered breathing was quantified based on self-report during telephone screening, and via first night polysomnography. Results from phone screening data reveal that individuals reporting depression were 5.86 times more likely to report a diagnosis of obstructive sleep apnea than presumptive control participants. Furthermore, all of the participants excluded for severe sleep-disordered breathing detected on the first night were participants with depression. These findings illustrate the importance of understanding the relationship between sleep-disordered breathing and depression, and suggest that screening and quantification of sleep-disordered breathing should be considered in depression research.

Treatment for graduate students: Blunting the emotional toll of postgraduate education.

OBJECTIVES: Graduate students are at greater risk of developing mental health concerns than other adults in their age group. Despite the need for care within this population, there is a lack of literature on accessible interventions designed specifically to meet the needs of graduate students. The present study examines the efficacy of a novel intervention: Mood Lifters for Graduate Students (ML-GS). METHOD: This study is a clinical trial with randomization. The sample size consisted of 131 participants. The average age was 25.95 years, and the sample was 88.5% women, 61.8% White, and 65.6% straight or heterosexual. Participants completed the same survey before and after participating in ML-GS, as well as 1-month after completing ML-GS. Three measures from those surveys were examined in this study: Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Stress Scale. Two-way mixed-design analyses of variance (ANOVAs) and repeated measures ANOVAs were used to analyze these data. RESULTS: Results indicated that participants enrolled in ML-GS experienced significant, clinically meaningful reductions in depression, anxiety, and stress, when compared to their waitlist counterparts. The changes made during the ML-GS program were also maintained at the 1-month follow-up. CONCLUSIONS: These findings suggest that ML-GS is effective in reducing depression, anxiety, and stress among graduate students. It may be a good solution for the large demand for mental health support in that population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An investigation into the effectiveness of Mood Lifters in the context of trauma exposure.

A large proportion of adults experiencing mental health problems do not receive care due to structural and attitudinal barriers. Mood Lifters (ML) is an evidence-based mental wellness program designed to reduce depression, anxiety, and stress symptoms. This study aims to extend the literature by examining whether ML reduces posttraumatic stress disorder (PTSD) symptoms, and if childhood trauma (CT) affects treatment outcomes. We hypothesized that ML will be effective for all symptoms. However, we predicted that those who endorse higher levels of CT would experience a diminished impact of ML on their symptoms. Graduate students and young professionals (N = 221), a demographic that is known to have greater mental health concerns, were randomly assigned to either the waitlist condition (n = 78) or the intervention condition (n = 143). Before and after ML participation, participants completed a series of questionnaires about their symptoms. ML reduced symptoms of PTSD for participants who received the intervention relative to the waitlist. Further, we also observed that while the overall regression models with CT predict posttreatment scores for all the clinical symptoms, the CT variable itself was predictive of only posttreatment anxiety. Unexpectedly, given that CT is often associated with less improvement, we found that those at all levels of CT experienced similar reductions in depression, anxiety and PTSD symptoms. Taken together, ML is a viable option to help people reduce depression, anxiety, stress, and PTSD regardless of the level of CT exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reductions in regional theta power and fronto-parietal theta-gamma phase-amplitude coupling during gaze processing in bipolar disorder.

Impaired social cognition is common in bipolar disorder (BD) and predicts poor functional outcomes. A critical determinant of social cognition is the ability to discriminate others' gaze direction, and its alteration may contribute to functional impairment in BD. However, the neural mechanisms underlying gaze processing in BD are unclear. Because neural oscillations are crucial neurobiological mechanisms supporting cognition, we aimed to understand their role in gaze processing in BD. Using electroencephalography (EEG) data recorded during a gaze discrimination task for 38 BD and 34 controls (HC), we examined: theta and gamma power over bilateral posterior and midline anterior locations associated with early face processing and higher-level cognitive processing, and theta-gamma phase-amplitude coupling (PAC) between locations. Compared to HC, BD showed reduced midline-anterior and left-posterior theta power, and diminished bottom-up/top-down theta-gamma PAC between anterior/posterior sites. Reduced theta power and theta-gamma PAC related to slower response times. These findings suggest that altered theta oscillations and anterior-posterior cross-frequency coupling between areas associated with higher-level cognition and early face processing may underlie impaired gaze processing in BD. This is a crucial step towards translational research that may inform novel social cognitive interventions (e.g., neuromodulation to target specific oscillatory dynamics) to improve functioning in BD.

Reduced theta-band neural oscillatory activity during affective cognitive control in bipolar I disorder.

Individuals with bipolar I disorder (BD) have difficulty inhibiting context-inappropriate responses. However, neural mechanisms of impaired cognitive control over impulsive behaviors, especially in response to emotion, are unclear. Theta-band neural oscillatory activity over midfrontal areas is thought to reflect cognitive control. The current study examined behavioral performance and theta-band activity during inhibition to affective stimuli in BD, relative to healthy control participants (HC). Sixty-seven participants with BD and 48 HC completed a Go/No-Go task with emotional face stimuli during electroencephalography (EEG) recording. Behavior was measured with reaction time, discriminability (d') and response bias (ß). Time-frequency decomposition of EEG data was used to extract event-related theta-band (4-7 Hz) neural oscillatory power and inter-trial phase consistency (ITPC) over midline fronto-central areas. Behavior and theta-band activity were compared between groups, while covarying for age. Participants with BD exhibited slower response execution times on correct Go trials and reduced behavioral discrimination of emotional versus neutral faces, compared to HC. Theta-band power and ITPC were reduced in BD relative to HC. Theta-band power was higher on No-Go trials than Go trials. The magnitude of differences in theta-band activity between Go/No-Go trial types did not differ between groups. Increased theta-band power was associated with faster response execution times, greater discrimination of differing facial expressions, and stronger tendency to respond both across the full sample and within the BD group. Attenuated midline fronto-central theta-band activity may contribute to reduced cognitive control and maladaptive behavioral responding to emotional cues in individuals with BD.

Feeling blue or turquoise? Emotional differentiation in major depressive disorder.

Some individuals have very specific and differentiated emotional experiences, such as anger, shame, excitement, and happiness, whereas others have more general affective experiences of pleasure or discomfort that are not as highly differentiated. Considering that individuals with major depressive disorder (MDD) have cognitive deficits for negative information, we predicted that people with MDD would have less differentiated negative emotional experiences than would healthy people. To test this hypothesis, we assessed participants' emotional experiences using a 7-day experience-sampling protocol. Depression was assessed using structured clinical interviews and the Beck Depression Inventory-II. As predicted, individuals with MDD had less differentiated emotional experiences than did healthy participants, but only for negative emotions. These differences were above and beyond the effects of emotional intensity and variability.

Event-related potential correlates of affective response inhibition in bipolar I disorder: Comparison with schizophrenia.

BACKGROUND: Individuals with bipolar I disorder (BD) have difficulty inhibiting context-inappropriate responses. The neural mechanisms contributing to these difficulties, especially in emotional contexts, are little understood. This study aimed to inform mechanisms of impaired impulsivity control in response to emotion in BD, and whether response inhibition indices are altered to a similar degree in schizophrenia spectrum disorders (SZ). We examined alterations to behavioral performance and event-related potentials (ERPs) during inhibition to affective stimuli in BD, relative to healthy control participants (HC) and SZ. METHODS: Sixty-six participants with BD, 32 participants with SZ, and 48 HC completed a Go/No-Go task with emotional face stimuli while electroencephalography was recorded. Behavioral signal detection metrics (perceptual sensitivity, response bias) and ERPs (N200, P300) were compared across groups. RESULTS: Relative to HC, participants with BD showed reduced (1) discrimination of Go vs. No-Go stimuli (i.e., emotional vs. neutral faces), and (2) P300 amplitudes elicited by emotional faces. Results similarly extended to SZ: BD and SZ groups did not differ on behavioral performance nor ERP amplitudes. LIMITATIONS: Aspects of the Go/No-Go task design may have limited findings, and medication effects on ERP amplitudes in patient samples cannot be fully ruled out. CONCLUSIONS: Findings suggest the difficulty participants with BD and SZ experienced on the current affective response inhibition task lied largely in discriminating between facial expressions. Difficulties with discriminating emotional from neutral expressions may contribute to difficulties with appropriate behavioral responding in social-affective contexts for individuals with BD and SZ.