How to study psychological mechanisms of mania? A systematic review on the methodology of experimental studies on manic mood dysregulation of leading theories on bipolar disorder.

INTRODUCTION: Although there are several psychological theories on bipolar disorders (BD), the empirical evidence on these theories through experimental studies is still limited. The current study systematically reviews experimental methods used in studies on the main theories of BD: Reward Hypersensitivity Theory (RST) or Behavioral Activation System (BAS), Integrative Cognitive Model (ICM), Positive Emotion Persistence (PEP), Manic Defense theory (MD), and Mental Imagery (MI). The primary aim is to provide an overview of the used methods and to identify limitations and suggest areas of improvement. METHODS: A systematic search of six databases until October 2023 was conducted. Study selection involved two independent reviewers extracting data on experimental study design and methodology. RESULTS: A total of 84 experimental studies were reviewed. BAS and RST were the most frequently studied theories. The majority of these experimental studies focus on mechanisms of reward sensitivity. Other important elements of the reviewed theories, such as goal setting and-attainment, situation selection (avoidance or approach), activation, affective/emotional reactivity, and regulatory strategies, are understudied. Self-report and neuropsychological tasks are most often used, while mood induction and physiological measures are rarely used. CONCLUSION: There is a need for more consensus on the operationalization of psychological theories of mania. Standardization of test batteries could improve comparability among studies and foster a more systematic approach to experimental research. Research on affective (activated) states is still underrepresented in comparison with studies on trait vulnerabilities.

Does parents' perceived style of setting limits to gaming matter? The interplay between profiles of parental mediation and BIS/BAS sensitivity in problematic gaming and online gambling.

INTRODUCTION: Parents try to prevent possible negative outcomes associated with gaming by setting rules on their adolescent's gaming behavior (i.e., restrictive mediation). Parents can use either more autonomy-supportive or more controlling styles to communicate those rules. Using a person-centered approach, this study aims to, first, identify profiles of parents' perceived degree of restrictive mediation in gaming and styles of communicating these rules (i.e., autonomy-supportive and controlling); second, to examine how adolescents in different profiles differ in terms of maladaptive gaming outcomes (i.e., problematic gaming, simulated, and online gambling); third, to investigate the moderating role of gaming frequency and adolescents' personality (i.e., behavioral inhibition system [BIS] sensitivity and behavioral activation system [BAS] sensitivity) in the associations between the parental profiles and the outcomes. METHODS: The study used quantitative, cross-sectional survey data from Belgian adolescents (N = 1651, mean age = 14.00 years, 51.2% boys), collected between November 2021 and February 2022 in schools. RESULTS: Cluster analysis yielded four profiles of perceived restrictive mediation: an exclusively controlling one, an autonomy-supportive one, one where parents used a perceived mix of both communication styles, and one where there was an overall perceived lack of restrictive mediation. Adolescents in the controlling profile displayed the most maladaptive outcomes. Some of the associations between the parental profiles and the outcomes were stronger for more frequent gamers and for adolescents scoring higher on both BIS and BAS sensitivity. CONCLUSION: Associations between the parental profiles and gaming outcomes were theoretically meaningful, yet small in terms of effect size.

Approachability and Credibility of Virtual Character Faces: The Role of the Horizontal Viewing Angle.

OBJECTIVE: The present work explores how the horizontal viewing angle of a virtual character's face influences perceptions of credibility and approachability. BACKGROUND: When encountering virtual characters, people rely both on credibility and approachability judgments to form a first impression of the depicted virtual character. Research shows that certain perceptions are preferred either on frontal or tilted faces, but not how approachability or credibility judgments relate to horizontal viewing angles in finer granularity between 0° and 45°. METHOD: 52 participants performed a two-alternative forced choice (2AFC) task rating 240 pairwise comparisons of 20 virtual character faces shown in four horizontal viewing angles (0°, 15°, 30°, and 45°) on approachability and credibility. They also rated scales on individual differences based on the BIS-BAS framework (behavioral inhibition system, drive, and reward responsiveness), self-esteem, and personality traits (neuroticism, loneliness). RESULTS: Both approachability and credibility were negatively related to the horizontal viewing angle, but the negative relationship was less pronounced for approachability. Notably, 15° tilted faces were associated with higher approachability than frontal faces by people scoring high in reward responsiveness, drive, and self-esteem, and scoring low in neuroticism and loneliness. CONCLUSION: Our findings highlight the conditions under which showing a virtual character's face is preferred in a horizontally 15° tilted over a frontal position. APPLICATION: The differential impact of the horizontal viewing angle on approachability and credibility should be considered when displaying virtual character faces.

Coping and Conformity Motives Mediate the Joint Effects of the Behavioral Inhibition and Approach Systems on Alcohol Problems in Young Adults.

Background: Gray's original Reinforcement Sensitivity Theory (RST) posits that an oversensitive behavioral inhibition system (BIS) may increase risk for negative-reinforcement-motivated drinking, given its role in anxiety. However, existing data provides mixed support for the BIS-alcohol use association. The inconsistent evidence is not surprising, as the revised RST predicts that the behavioral approach system (BAS) should moderate the effect of the BIS on alcohol use. A strong BAS is thought to bring attention to the negatively reinforcing effects of alcohol, leading to problem drinking among those with a strong BIS. While emerging results support this interaction, we still have much to learn about the mechanisms underlying this effect on alcohol use. Accordingly, we examined motives for alcohol use as mediators of the joint associations of the BIS and the BAS on drinking behaviors. Specifically, our central hypothesis was that individuals with a strong BIS and a strong BAS would endorse increased negative reinforcement motives for drinking (coping and conformity motives), which in turn would predict heavy drinking and alcohol problems. Method: Participants (N=346; 195 women) completed study measures as part of the baseline assessment for a larger study. Results: Overall, results partially supported the hypotheses. Mediated moderation analyses showed that the indirect effect of the BIS on alcohol problems, through coping and conformity motives, was strongest at high levels of the BAS. This effect was not supported for alcohol use. Conclusions: Our findings suggest that clinical interventions should target coping and conformity reasons for drinking among anxious, reward responsive, young adults.

Exploring approach motivation: Correlating self-report, frontal asymmetry, and performance in the Effort Expenditure for Rewards Task.

Frontal EEG asymmetry has been investigated as a physiological metric of approach motivation, with higher left frontal activity (LFA) suggested to reflect approach motivation. However, correlations between LFA and traditional metrics of approach motivation (e.g., scores from the behavioral inhibition system/behavioral approach system [BIS/BAS] survey) are inconsistent. It is also not clear how LFA correlates to approach motivation on an observable, behavioral level. Here, we tested correlations between BIS/BAS scores, LFA, and performance in the Effort Expenditure for Rewards Task (EEfRT). In our sample (n = 49), BIS/BAS results did not correlate to LFA values (resting or task states), and were also unrelated to EEfRT performance variables. We found evidence of significant and distinct correlations between LFA and EEfRT performance. Resting-state LFA positively correlated to effort expenditure on lower utility trials, where reward size and/or probability were suboptimal. Task-onset LFA captured in the first 5 min of the task was related to overall behavioral performance in the EEfRT. High task-onset LFA correlated to high trial completion rates, high-effort trial selection percentages, and overall monetary earnings. One interpretation of these initial findings is that resting-state LFA reflects approach tendencies to expend effort, but that this extends to suboptimal situations, whereas task-state LFA better reflects effortful approach toward high-utility goals. Given the relatively small sample size and the risk of Type I/II errors, we present the study as exploratory and the results as preliminary. However, the findings highlight interesting initial links between LFA and EEfRT performance. The need for larger replication studies is discussed.

Hypnotisability-related interoceptive awareness and inhibitory/activating emotional traits.

Emotions are influenced by several individual factors. Hypnotizability - a psychophysiological trait associated with morpho-functional cerebral and cerebellar variations able to sustain differences in interoception and emotion - could be one of them. The aims of the study were to find out possible differences in Interoceptive Awareness (IA) and in the emotional traits sustained by the Behavioral Inhibition/Activation System (BIS/BAS) in participants with high (highs), medium (mediums) and low (lows) hypnotizability and to investigate the association of interoceptive awareness and BIS/BAS related emotional traits as a function of hypnotizability. Thus, IA and BIS/BAS were studied in 284 subjects of both genders by the Multidimensional Assessment of Interoceptive Awareness (MAIA) and by BIS/BAS scales, respectively. Significantly lower BIS scores (lower inhibitory control/conflict monitoring) in highs and lows with respect to mediums and significantly higher IA (proneness to notice and interpret interoceptive information) in highs with respect to mediums and lows were found. In addition, different correlations between MAIA and BIS/BAS scales were observed in the three groups, indicating different hypnotizability-related associations.The hypnotizability-related relation between interoceptive awareness and emotional traits could be accounted for by different models and their knowledge may be relevant to the science of emotion and to clinical applications.

The predictive value of Approach and Avoidance tendencies on the onset and course of depression and anxiety disorders.

BACKGROUND: Trait and automatic approach-avoidance (AA) tendencies are central concepts in research on affective disorders. We longitudinally examined the associations of trait and automatic AA tendencies with the risk of onset and chronicity of anxiety and depressive disorders. METHODS: Participants were subdivided into those with (n = 766) versus without (n = 1,636) a current anxiety or depression diagnosis at baseline. Clinical diagnoses were reassessed after 2-year follow-up. Automatic AA tendencies in reaction to facial expressions were assessed using the Approach-Avoidance Task, whereas self-reported trait AA tendencies were assessed using the Behavioral Inhibition System and the Behavioral Activation System scales. Analyses were adjusted for socio-demographics (basic adjustment) and for severity and history of psychopathology (full adjustment). RESULTS: Stronger trait avoidance tendencies predicted both increased risk of onset and increased risk of a chronic course of anxiety disorders after full adjustment (Odds ratioonset  = 1.55, P < .001, and Odds ratiochronicity  = 1.31, P = .03). The associations between stronger trait avoidance tendencies and increased risk of onset and chronicity of depressive disorders were no longer significant after full adjustment. In contrast, trait approach tendencies and automatic AA tendencies were not related to onset or chronicity of disorders. CONCLUSIONS: Increased trait avoidance tendencies are a risk factor for affective disorders in general, with possibly a slightly more pronounced role in anxiety than depressive disorders. This underlines the importance of addressing trait avoidance tendencies in both the treatment and aftercare of affective disorders.

Fractionating negative and positive affectivity in handedness: Insights from the Reinforcement Sensitivity Theory of personality.

The Annett Hand Preference Questionnaire (AHPQ), as modified by Briggs and Nebes [(1975). Patterns of hand preference in a student population. Cortex, 11(3), 230-238. doi: 10.1016/s0010-9452(75)80005-0] , was administered to a sample of 177 participants alongside the Reinforcement Sensitivity Theory of Personality Questionnaire [RST-PQ; Corr, P. J., & Cooper, A. (2016). The Reinforcement Sensitivity Theory of Personality Questionnaire (RST-PQ): Development and validation. Psychological Assessment. doi: 10.1037/pas000 ], which measures two factors of defensive negative emotion, motivation and affectivity-the Behavioural Inhibition System (BIS) and the Fight-Flight-Freeze System (FFFS)-and one positive-approach dimension related to reward sensitivity, persistence and reactivity-the Behavioural Approach System. We sought to clarify the nature of negative, and positive, affectivity in relation to handedness. ANOVAs and multiple regression analyses converged on the following conclusions: left-handers were higher on the BIS, not the FFFS, than right-handers; in right-handers only, strength of hand preference was positively correlated with the FFFS, not the BIS. The original assessment method proposed by Annett was also used to assess handedness, but associations with RST-PQ factors were not found. These findings help us to clarify existing issues in the literature and raise new ones for future research.

The Moderating Role of Maternal Depression in the Relation Between Adolescent Behavioral Inhibition and Maternal Critical Expressed Emotion.

Behavioral inhibition is associated with a range of negative affective states and behaviors in adolescents which may elicit critical expressed emotion (EE-Crit) among mothers. Whether the relation between adolescent behavioral inhibition and maternal EE-Crit may depend on the presence of maternal depression is unknown. Therefore, a total of N = 81 biological mother/adolescent daughter dyads were recruited: mothers with a history of major depressive disorder (n = 45) and never-depressed mothers (non-depressed: n = 36). Structured clinical interviews were administered, daughters reported their behavioral inhibition and mothers reported daughter-directed maternal EE-Crit. Maternal depression was a moderator such that higher daughter behavioral inhibition was associated with greater EE-Crit among depressed mothers, specifically. There were no group differences for daughter behavioral inhibition or maternal EE-Crit. These findings highlight the significant role that maternal depression may play in relation to adolescent behavioral inhibition, EE-Crit, and risk for the development of adolescent psychopathology.

Reward and Cognition: Integrating Reinforcement Sensitivity Theory and Social Cognitive Theory to Predict Drinking Behavior.

BACKGROUND: Both Reinforcement Sensitivity Theory and Social Cognitive Theory have been applied to understanding drinking behavior. We propose that theoretical relationships between these models support an integrated approach to understanding alcohol use and misuse. OBJECTIVES: We aimed to test an integrated model in which the relationships between reward sensitivity and drinking behavior (alcohol consumption, alcohol-related problems, and symptoms of dependence) were mediated by alcohol expectancies and drinking refusal self-efficacy. METHODS: Online questionnaires assessing the constructs of interest were completed by 443 Australian adults (M age = 26.40, sd = 1.83) in 2013 and 2014. RESULTS: Path analysis revealed both direct and indirect effects and implicated two pathways to drinking behavior with differential outcomes. Drinking refusal self-efficacy both in social situations and for emotional relief was related to alcohol consumption. Sensitivity to reward was associated with alcohol-related problems, but operated through expectations of increased confidence and personal belief in the ability to limit drinking in social situations. Conversely, sensitivity to punishment operated through negative expectancies and drinking refusal self-efficacy for emotional relief to predict symptoms of dependence. CONCLUSIONS: Two pathways relating reward sensitivity, alcohol expectancies, and drinking refusal self-efficacy may underlie social and dependent drinking, which has implications for development of intervention to limit harmful drinking.

Handedness and behavioural inhibition system/behavioural activation system (BIS/BAS) scores: A replication and extension of Wright, Hardie, and Wilson (2009).

The Annett Hand Preference Questionnaire (AHPQ) as modified by Briggs and Nebes was administered along with Carver and White's behavioural inhibition system (BIS) and behavioural activation system (BAS) scale and a shortened form of the Big Five personality questionnaire to 92 university students. After eliminating the data from five respondents who reported having changed handedness and one outlier, there was a significant sex difference in mean BIS scores, with females (n = 43) scoring higher than males (n = 43). Replicating the results of Wright, Hardie and Wilson, non-right-handers (n = 36) had significantly higher mean BIS score than right-handers (n = 50). Controlling for sex of participant, neuroticism and BAS sub-scale scores in hierarchical regression analyses left this BIS effect substantially unaffected. There was no handedness or sex difference on any of the three BAS sub-scales. Further analyses revealed no association between strength, as distinct from direction, of handedness and BIS (or BAS) scores. The findings are discussed with reference to recent developments in reinforcement sensitivity theory on which BIS/BAS variables are based.

BAS Reward Responsiveness: A unique predictor of positive psychological functioning.

Previous research on Reinforcement Sensitivity Theory has well-characterized the Behavioral Inhibition System in terms of its behavioral and emotional manifestations, but the Behavioral Approach System (BAS) is less well-defined, particularly regarding the prominence of reward sensitivity versus impulsivity. Furthermore, few researchers evaluate both systems in one model. We evaluated the relationship between Carver and White's (1994) BIS/BAS Scales and areas of psychological functioning including internalizing, externalizing, affect regulation, and well-being. 497 undergraduates completed a battery of self-report measures. Two structural equation models indicate that the Reward Responsiveness subscale uniquely predicts adaptive functioning across all domains. Reward Responsiveness may be a more pure measure of BAS than other BAS traits and may be important for resilience from maladaptive psychological functioning.

Pulling the lever in a hurry: the influence of impulsivity and sensitivity to reward on moral decision-making under time pressure.

BACKGROUND: Making timely moral decisions can save a life. However, literature on how moral decisions are made under time pressure reports conflicting results. Moreover, it is unclear whether and how moral choices under time pressure may be influenced by personality traits like impulsivity and sensitivity to reward and punishment. METHODS: To address these gaps, in this study we employed a moral dilemma task, manipulating decision time between participants: one group (N = 25) was subjected to time pressure (TP), with 8 s maximum time for response (including the reading time), the other (N = 28) was left free to take all the time to respond (noTP). We measured type of choice (utilitarian vs. non-utilitarian), decision times, self-reported unpleasantness and arousal during decision-making, and participants' impulsivity and BIS-BAS sensitivity. RESULTS: We found no group effect on the type of choice, suggesting that time pressure per se did not influence moral decisions. However, impulsivity affected the impact of time pressure, in that individuals with higher cognitive instability showed slower response times under no time constraint. In addition, higher sensitivity to reward predicted a higher proportion of utilitarian choices regardless of the time available for decision. CONCLUSIONS: Results are discussed within the dual-process theory of moral judgement, revealing that the impact of time pressure on moral decision-making might be more complex and multifaceted than expected, potentially interacting with a specific facet of attentional impulsivity.

Temperament Based Personality Types in Community-Dwelling Older Adults: A Latent Profile Analysis.

Three adaptive trait-based personality types have been replicated across ages, cultures, clinical problems and clustering methods: Resilient, Undercontrolled and Overcontrolled type (RUO). Recently there is growing interest in and importance of biopsychosocial transdiagnostic factors underlying personality types, such as temperamental reactivity and self-regulation. Latter can be understood in terms of Behavioural Inhibition (BIS), Behavioural Activation Systems (BAS) and Effortful Control (EC). The occurrence of temperament based RUO types has not yet been confirmed in older adults with or without a mental disorder. Therefore, based on a person-centered approach, the current study investigates whether RUO types can be corroborated in older adults based on the aforementioned temperamental factors. Latent profile analysis yielded two distinct personality profiles in community-dwelling over-60s, which we tentatively labeled a resilient (n = 167) and overcontrolled/inhibited type (n = 241). Compared to the resilient type, the overcontrolled/inhibited type scored lower on EC and higher on BIS. We could not corroborate an undercontrolled type (profiles scored equally on BAS). Group comparisons revealed that overcontrolled/inhibited older adults demonstrated significantly more clinical symptoms, higher emotional instability, lower scores on adaptive traits, less resilience and were significantly more likely to use passive and avoidant coping styles, compared to resilient older adults.

Predicting individual differences in behavioral activation and behavioral inhibition from functional networks in the resting EEG.

The behavioral activation system (BAS) and behavioral inhibition system (BIS) are thought to underly affective dispositions and self-regulatory processes. The BAS is sensitive to reward and involved in approach behaviors, and the BIS is sensitive to punishment and involved in avoidance behaviors. Trait BAS and BIS relate to distinct behavioral profiles and neural activity, but little is known about how trait BAS and BIS relate to functional networks in EEG. We applied a data-driven method called connectome predictive modeling (CPM) to identify networks relating to trait BAS and BIS and tested whether the strength of those networks predicted trait BAS and BIS in novel subjects using a leave-one-out cross-validation procedure. Adult participants (N = 107) completed a resting state task with eyes closed and eyes open, and trait BAS and BIS were measured via Carver and White's (1994) BIS and BAS scales. We hypothesized distinct positive (more synchronization) and negative (less synchronization) networks would relate to trait BAS and BIS. For eyes closed, we identified two negative networks, one in theta and one in alpha predicted BIS. We identified three positive networks, one in theta and one in beta predicted Fun Seeking and one in theta predicted Drive. For eyes open, negative theta and alpha networks predicted BIS, a positive theta network predicted Fun Seeking, and a negative gamma network predicted mean BAS. Visualization of the networks are presented. Discussion centers on the observed networks and how to advance application of CPM to EEG, including with clinical implications.

Chronotype and sensory-processing sensitivity: A cross-sectional survey.

Here we examined the possibility of a relationship of sensory processing sensitivity (SPS) with chronotype in a German-speaking sample of N = 1807 (1008 female, 799 male) with a mean age of 47.75 ± 14.41 y (range: 18-97 y). The data were collected using an anonymous online questionnaire (Chronotype: one item of the Morning-Evening-Questionnaire, as well as typical bedtimes on weekdays and weekends; SPS: German version of the three-factor model ; Big Five: NEO-FFI-30) between 21 and 27 April 2021. Results. We found morningness to correlate with the SPS facet low sensory threshold (LST), while eveningness correlated to aesthetic sensitivity (AES) and marginally significant to ease of excitation (EOE). Discussion: The results show that the correlations between chronotype and the Big Five personality traits are not consistent with the direction of the correlations between chronotype and the SPS facets. The reason for this could be different genes that are responsible for the individual traits influence each other differently depending on their expression.

Measuring Personality Systems in Older Adults: Age-Neutrality of the Dutch BIS/BAS Questionnaire.

Introduction: With a rapidly aging population, age-neutrality of psychological instruments is becoming ever more important for accurate assessment of older adults. This study aims to test the age-neutrality of the Dutch Behavioral Inhibition System/Behavioral Approach System (BIS/BAS) scales by means of Differential Item Functioning (DIF) and Differential Test Functioning (DTF) analyses. Methods: DIF and DTF analyses were conducted using an odds ratio approach. Potential DIF was examined for the two primary scales and three BAS subscales in 390 Dutch-speaking participants divided over three age groups. Results: Overall, the BIS-BAS scales lacked age-neutrality when comparing older adults to young adults: eight out of 20 items (ie, 40%) displayed DIF according to the adjusted Bonferroni corrected cut-offs, which exceeds the threshold of 25% for large DIF. Thus, for 40% of the test items, items were differently endorsed by young and older adults with the same position on the construct measured by the item. Therefore, the implications of the item-level DIF on the scale level were investigated across age groups. DTF analyses revealed large DTF for all BIS and BAS scales according to the adjusted Bonferroni corrected cut-offs. Discussion: DIF found in items on the BIS scale and BAS-Drive and BAS-Fun Seeking scale can probably be explained by a difference in degree of expression across age groups. A solution could be the development of age-specific norms. DIF on BAS-Reward Responsiveness subscale could be partly due to measuring a different construct across age groups. Rephrasing or replacing such items with DIF may increase age-neutrality of the BIS/BAS Scales.

Association of polymorphisms rs4680 of the Catechol-O-Methyltransferase gene and rs6265 of the brain derived neurotrophic factor gene with the behavioral inhibition and behavioral activation systems.

Background: The Behavioral Inhibition System (BIS) comprises limbic circuitry implicated in avoidance behaviors. Its increased activation has been identified as a risk factor for anxiety and depressive disorders. In addition, both Catechol-O-Methyltransferase (COMT) and Brain Derived Neurotrophic Factor (BDNF) have been postulated as candidate genes that constitute a vulnerability for the onset of anxiety and depressive disorders. The aim of this study was to evaluate the possible association between the rs4680 polymorphism of the COMT gene and the rs6265 polymorphism of the BDNF gene with the BIS and the Behavioral Activation System (BAS) in a population sample from Colombia. Methods: Genetic information was obtained by extracting DNA from blood samples of 80 participants and using Taqman probes designed for each polymorphism. In addition, participants completed a BIS/BAS scale in order to establish a neuropsychological classification. Results: The frequency of the Met allele of the BDNF gene was greater in the group with BIS sensitivity compared to the group with BAS sensitivity. On the contrary, the frequency of the Met allele of the COMT gen did not show a significant association with the BIS. Conclusions: The rs6265 polymorphism of BDNF gene is associated with the BIS which in turn constitutes a risk factor for anxiety and depression.

The roles of trait and process resilience in relation of BIS/BAS and depressive symptoms among adolescents.

Background: Extensive literature revealed the relations of depression with behavioral inhibition system (BIS) and behavioral activation system (BAS) as vulnerability and with resilience separately. Besides, the concept of resilience is still broad and ambiguous. Thus, this study aimed to reveal the mediation of two aspects of resilience: trait and process, in the relations of BIS and BAS to depression among adolescents. Methods: The data set used in this study was a cross-sectional survey among 965 adolescents. The obtained data from the self-reported questionnaires used in this study were as below: Depression Serf-Rating Scale for Children (DSRS-C), Behavioral Inhibition and Behavioral Activation System Scale (BIS/BASS), and Bidimensional Resilience Scale (BRS). Structural equation modeling (SEM) was conducted to verify the hypothesized relations among BIS/BAS, trait and behavior resilience, and depressive symptoms. Results: The obtained indices of fit from SEM were good or sufficient (χ 2 = 562.911, df = 96, p < 0.001; CFI = 0.925; NFI = 0.913; RMSEA = 0.073, 90% CI [0.067, 0.079]; SRMR = 0.066). And the modeling showed that both BIS/BAS directly and indirectly influenced to depression. The indirect effects of BIS/BAS were mediated only trait resilience except the indirect effect of BIS via behavioral resilience. Discussion: Our results suggested that trait resilience played a significant mediation role in the relationships between BIS/BAS and depression. Trait but not process resilience could be considered suitable as an intervention target in line with decreasing depression.

Self-construal and behavioral motivation systems among patients with depression in Indonesia: A hospital-based study.

Objective: To validate Indonesian versions of two social/cultural psychological scales: the Self-Construal Scale (SCS) that measures independent and interdependent cultural values, and the Behavioral Inhibition (Avoidance) System and Behavioral Approach System (BIS/BAS) that measures motivation focus. We also explored the cultural background for the rising prevalence of depression in Indonesia. Design: Case (hospital)-control (population) study. Setting: Hasanuddin University Hospital (cases) and Makassar city region (controls), Indonesia. Participants: Participants (N = 369) were 165 patients with depression recruited from a university hospital, and 204 healthy controls without a history of mental disorders recruited from locations within a 30-minute walk from the hospital. Outcome measures: Depression was diagnosed by psychiatrists with reference to Indonesian mental disorder guidelines (Pedoman Penggolongan dan Diagnosa Gangguan Jiwa edisi 3). Participants' independent and interdependent cultural values, and neural motivational systems were measured with the SCS and BIS/BAS. Results: Exploratory and confirmatory factor analyses showed that our revised 12-item SCS and the 13-item, three-factor BIS/BAS had a good model fit for the Indonesian population. MANCOVA showed that the SCS Independent subscale and the BAS subscales were significantly associated with depression after adjustment for age, sex, religion, education, and occupation. Conclusion: These findings may guide provision of appropriate treatment for patients based on their social and cultural environment. In addition, this study contributes to understanding underlying reasons for the increasing prevalence of depression in Indonesia, where society is changing from traditional collectivism to global individualism.