Spontaneous infant crying modulates vagal activity in real time.

Porges' polyvagal theory (1991) proposes that the activity of the vagal nerve modulates moment-by-moment changes in adaptive behavior during stress. However, most work, including research with infants, has only examined vagal changes at low temporal resolutions, averaging 30+ s across phases of structured stressor paradigms. Thus, the true timescale of vagal regulation-and the extent to which it can be observed during unprompted crying-is unknown. The current study utilized a recently validated method to calculate respiratory sinus arrhythmia (RSA) dynamically at a high resolution of 5 Hz (updated every 200 ms) in a home-based infant study. Using an event-related analysis, we calculated the relative change in RSA around the onset of naturally occurring unprompted instances of n = 41 infants' 180 crying events. As predicted, RSA significantly decreased after the onset of crying compared to non-crying chance changes in RSA. Decreasing trends in RSA were driven by infants with higher pre-cry RSA values, infants rated lower in Negative Affectivity, and those rated both high and low in Orienting by their mothers. Our results display the timescale of RSA in spontaneous and naturalistic episodes of infant crying and that these dynamic RSA patterns are aligned with real-time levels of RSA and also caregiver-reported temperament.

Effectiveness of different bathing methods on physiological indexes and behavioral status of preterm infants: a systematic review and meta-analysis.

BACKGROUND: Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The objective of this meta-analysis is to evaluate the effectiveness of different bath methods on physiological indexes and behavioral status of preterm infants. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO(CRD42022377657). PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Sino Med, China National Knowledge Internet (CNKI) and Wan-Fang database were systematically searched for randomized controlled trials on the effects of different bath methods for preterm infants. The retrieval time was from the establishment of the database to February 2023. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Reman Version 5.4 was used for meta-analysis and Stata 16.0 software for publication bias Egger's test. RESULTS: A total of 11 RCTs with 828 preterm infants were included. The results of meta-analysis showed that the body temperature and oxygen saturation of preterm infants in the sponge bath group were lower than those in conventional tub bath group (SMD = -0.34; 95%CI -0.56 to -0.12; I2 = 0; p < 0.01), (MD = -0.39; 95%CI -0.76 to -0.02; I2 = 39%; p = 0.04), while the heart rates were higher than those in conventional tub bath group(MD = 5.90; 95%CI 0.44 to 11.35; I2 = 61%; p = 0.03). Preterm infant's body temperature and blood oxygen saturation of in swaddle bath group were higher than those in conventional tub bath group (MD = 0.18; 95%CI 0.05 to 0.30; I2 = 88%; p < 0.01), (MD = 1.11; 95%CI 0.07 to 2.16; I2 = 86%; p = 0.04), respiratory rates were more stable compared with infants in conventional tub bath group (MD = -2.73; 95%CI -3.43 to -2.03; I2 = 0; p < 0.01). The crying duration, stress and pain scores of preterm infants in swaddle bath group were lower than those in conventional tub bath group (SMD = -1.64; 95CI -2.47 to -0.82; I2 = 91%; p < 0.01), (SMD = -2.34; 95%CI -2.78 to -1.91; I2 = 0; p < 0.01), (SMD = -1.01; 95%CI -1.40 to -0.62; I2 = 49%; p < 0.01). Egger's test showed no publication bias in body temperature, respiratory rate, oxygen saturation, and crying duration. CONCLUSIONS: Swaddle bath is the best bathing method than conventional tub bath and sponge bath in maintaining the stability of preterm infant's body temperature, blood oxygen saturation and respiratory rate. In addition, swaddle bath also plays a role in reducing cry duration, stress scores, and pain levels of preterm infant compared with conventional tub bath and sponge bath. However, due to the important heterogeneity in some outcomes, future studies with larger sample size and more appropriately design are needed to conduct before recommendation. TRIAL REGISTRATION: Prospero CRD42022377657.

Maternal depressive symptoms and affective responses to infant crying and laughing.

Depressive symptoms are common in the postpartum period and can affect mother-infant interaction. To better understand the role of depressive symptoms in the mother-infant interchange, this study examined whether maternal depressive symptoms are associated with self-reported, physiological, and facial expressive responses to infant crying and laughing sounds. A nonclinical sample was used, consisting of 101 mothers (Age M = 30.88 years, 33% scored 7 or higher on the Edinburgh Postnatal Depression Scale) with a young child. Mothers were exposed to standard infant crying and laughing sounds. Affect, perception of crying and laughing, intended caregiving responses, skin conductance level reactivity, and facial expressive responses to infant crying and laughing were measured. Higher levels of depressive symptoms were associated with more self-reported negative affect in general and a more negative perception of infant crying. Depressive symptoms were not associated with intended caregiving responses and physiological responses to infant crying. Infant laughing increased self-reported positive affect and happy facial expressions in mothers with all levels of depressive symptoms. Higher levels of depressive symptoms were associated with higher sad facial expressivity in general. Depressive symptoms were not related to positive perception of infant laughing, intended caregiving responses, and physiological responses to infant laughing. The findings suggest that mothers who score high on depressive symptoms send subtle facial cues showing sadness, which may overshadow happy facial expressions during infant laughing and may affect mother-infant interaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Observational study comparing heart rate in crying and non-crying but breathing infants at birth.

BACKGROUND: Stimulating infants to elicit a cry at birth is common but could result in unnecessary handling. We evaluated heart rate in infants who were crying versus non-crying but breathing immediately after birth. METHODS: This was single-centre observational study of singleton, vaginally born infants at ≥33 weeks of gestation. Infants who were crying or non-crying but breathing within 30 s after birth were included. Background demographic data and delivery room events were recorded using tablet-based applications and synchronised with continuous heart rate data recorded by a dry-electrode electrocardiographic monitor. Heart rate centile curves for the first 3 min of life were generated with piecewise regression analysis. Odds of bradycardia and tachycardia were compared using multiple logistic regression. RESULTS: 1155 crying and 54 non-crying but breathing neonates were included in the final analyses. There were no significant differences in the demographic and obstetric factors between the cohorts. Non-crying but breathing infants had higher rates of early cord clamping <60 s after birth (75.9% vs 46.5%) and admission to the neonatal intensive care unit (13.0% vs 4.3%). There were no significant differences in median heart rates between the cohorts. Non-crying but breathing infants had higher odds of bradycardia (heart rate <100 beats/min, adjusted OR 2.64, 95% CI 1.34 to 5.17) and tachycardia (heart rate ≥200 beats/min, adjusted OR 2.86, 95% CI 1.50 to 5.47). CONCLUSION: Infants who are quietly breathing but do not cry after birth have an increased risk of both bradycardia and tachycardia, and admission to the neonatal intensive care unit. TRIAL REGISTRATION NUMBER: ISRCTN18148368.

Decoding brain basis of laughter and crying in natural scenes.

Laughter and crying are universal signals of prosociality and distress, respectively. Here we investigated the functional brain basis of perceiving laughter and crying using naturalistic functional magnetic resonance imaging (fMRI) approach. We measured haemodynamic brain activity evoked by laughter and crying in three experiments with 100 subjects in each. The subjects i) viewed a 20-minute medley of short video clips, and ii) 30 min of a full-length feature film, and iii) listened to 13.5 min of a radio play that all contained bursts of laughter and crying. Intensity of laughing and crying in the videos and radio play was annotated by independent observes, and the resulting time series were used to predict hemodynamic activity to laughter and crying episodes. Multivariate pattern analysis (MVPA) was used to test for regional selectivity in laughter and crying evoked activations. Laughter induced widespread activity in ventral visual cortex and superior and middle temporal and motor cortices. Crying activated thalamus, cingulate cortex along the anterior-posterior axis, insula and orbitofrontal cortex. Both laughter and crying could be decoded accurately (66-77% depending on the experiment) from the BOLD signal, and the voxels contributing most significantly to classification were in superior temporal cortex. These results suggest that perceiving laughter and crying engage distinct neural networks, whose activity suppresses each other to manage appropriate behavioral responses to others' bonding and distress signals.

Hush little baby, don't you cry: How aversion to infant distress calls drives caregiving.

Historically associated with aversion, the lateral habenula has a poorly characterized role in parenting. In this issue of Neuron, Lecca and colleagues1 show that these seemingly opposing roles converge in a subnucleus where aversion to pup cries may drive motivation for caregiving.

Effect of Palmar Grasp Reflex Stimulation on Physiological Parameters and Crying Time During Neonatal Bath: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to determine the effect of palmar grasp reflex stimulation during a neonatal bath on the physiological parameters and crying time of the newborn. DESIGN, SETTING, AND PARTICIPANTS: This study was designed as a parallel randomized clinical trial. Parents fully understood the study procedure at the Neonatal Intensive Care Unit in Turkey (N = 82). Both written and verbal consent was obtained from the parents. Newborns who were ineligible for tub bathing were excluded from the study. The babies in the control group were given baths according to the tub bathing standards. Babies in the experimental group were given palmar grasp reflex stimulation during the baths. The variables examined included body temperature, respiratory rate, pulse, oxygen saturation levels, and crying time. In all analyses, p < 0.05 was accepted as statistically significant. RESULTS: The heart rate of the experimental group was 5.2 beats per minute slower than the control group (χ2 = 12.272; p < 0.001). The respiratory rate of the experimental group was 1.3 lower per minute compared to the control group (χ2 = 43.219; p < 0.001). In addition, the oxygen saturation level (%) of the experimental group was 0.4 higher than the control group (χ2 = 5.793; p < 0.016). Crying time was higher in the control group during bathing (p < 0.001). CONCLUSION: The results showed that the palmar grasp reflex in newborn bathing helps to maintain the stability of physiological parameters and shortens the crying time of babies. Palmar grasp reflex stimulation is recommended in interventions that may cause stress.

Crying does not alleviate acute pain perception: Evidence from an experimental study.

BACKGROUND: Whereas previous studies revealed positive effects of emotional expressions such as swearing and laughing on acute pain, systematic research on the effects of crying on pain is missing. The rationale for the current study is that either a mere emotional distraction or changes in oxytocin and opioid levels represent a mechanism through which crying modulates pain, with the timing of mood changes as crucial information for distinguishing between potential mechanisms. METHODS: In two studies, we exposed participants (Study 1: n = 57; Study 2: n = 70) to a sad movie and measured their mood, and exposed them to pain induction procedures (electric shock and cold-pressor test, respectively) before and after the film. Dependent variables were pain threshold, tolerance, and intensity. In addition to baseline and one immediate post-crying mood and pain response measurement in both studies, in Study 2, we repeated these procedures 20 and 50 min later to discern between the potential role of neurobiological substances and distraction. RESULTS: Crying was elicited in 28 participants in Study 1 (49.1%) and 49 (70%) in Study 2. We found no systematic differences in pain and mood changes between criers and non-criers and no systematic dose-response relationship between crying and pain responses and mood. The only significant effects ran contrary to our hypotheses, showing detrimental effects of the occurrence (Study 1) and frequency of crying (both studies) on pain threshold. CONCLUSIONS: Results do not support the idea that crying has pain-alleviating effects, either via distraction or direct biological mechanisms. SIGNIFICANCE: Despite previous findings on pain alleviating effects of emotional expression and the widespread idea about the generally beneficial consequences of emotional crying, research on the possible pain alleviating effects of crying is largely missing. Two quasi-experimental studies demonstrated that crying induced in laboratory conditions does not alleviate acute pain responses, suggesting that role of crying in pain interventions is doubtful. Less directly, results cast light on the role of emotional distraction from acute pain and possible crying-related neurochemical changes.

Breastfeeding is related to atypical autonomic and behavior regulation in infants with a history of excessive crying.

The study investigated autonomic regulation during feeding in six-month old infants with a history of excessive crying (EC) and social-behavioral development at 12 and 24 months. When contrasted with non-EC infants (NEC), EC infants had atypical autonomic responses observed as dampened reductions in respiratory sinus arrhythmia (RSA) and decreases in heart period (HP) during feeding. EC infants demonstrated atypical autonomic regulation only if they were bottle-fed, while breastfed EC infants had patterns of autonomic regulation similar to NEC infants. Behavioral data suggest that while a history of EC was related to social-emotional behaviors at 12 and 24 months, breastfeeding may buffer the behavioral effects of EC on sociability at 24 months.

Tears do not influence competence in general, but only under specific circumstances: A systematic investigation across 41 countries.

Research on the effect of emotional tears on perceived competence has yielded an inconsistent pattern of findings, with some studies showing that tearful individuals may be perceived as less competent, while others report no such effect. These mixed results point to the likely existence of third variables influencing the link between tears and perceived competence and suggest that crying may affect competence only in specific circumstances. In the current project, we reexamine this link using a large, openly available dataset of responses to tearful faces collected across 41 countries and 7,007 participants (Zickfeld et al., 2021). Our results show that tears have no general effect on perceptions of competence but do reduce competence when crying is regarded as inappropriate (e.g., there is no clear reason for shedding tears) or when the target is perceived as helpless. Moreover, shedding tears increases competence when the target is perceived as honest. As emotional tears have been found to signal both helplessness and honesty, the interplay of these effects might result in no overall effect of tears on perceptions of competence. The present findings suggest that the link between emotional tears and perceived competence is highly context dependent. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An infant with inconsolable crying.

Inconsolable crying in infants can be caused by as simple as infantile colic to wide variety of pathologies. A thorough history, physical examination followed by laboratory and radiologic evaluation can identify the cause of inconsolable crying. We present a case of infant who presented with inconsolable crying and after extensive workup no cause could ne identified. Eventually after consultation scorpion envenomation was considered. Antivenom was administered and the patient returned to normal. Patient did not exhibit any signs of somatic or cranial nerve dysfunction with inconsolable crying and tachycardia as the only manifestation of envenomation. In summary "Bites and stings can cause inconsolable crying".

Pathological laughter and crying: insights from lesion network-symptom-mapping.

The study of pathological laughter and crying (PLC) allows insights into the neural basis of laughter and crying, two hallmarks of human nature. PLC is defined by brief, intense and frequent episodes of uncontrollable laughter or crying provoked by trivial stimuli. It occurs secondary to CNS disorders such as stroke, tumours or neurodegenerative diseases. Based on case studies reporting various lesions locations, PLC has been conceptualized as dysfunction in a cortico-limbic-subcortico-thalamo-ponto-cerebellar network. To test whether the heterogeneous lesion locations are indeed linked in a common network, we applied 'lesion network-symptom-mapping' to 70 focal lesions identified in a systematic literature search for case reports of PLC. In lesion network-symptom-mapping normative connectome data (resting state functional MRI, n = 100) is used to identify the brain regions that are likely affected by diaschisis based on the lesion locations. With lesion network-symptom-mapping we were able to identify a common network specific for PLC when compared with a control cohort (n = 270). This bilateral network is characterized by positive connectivity to the cingulate and temporomesial cortices, striatum, hypothalamus, mesencephalon and pons, and negative connectivity to the primary motor and sensory cortices. In the most influential pathophysiological model of PLC, a centre for the control and coordination of facial expressions, respiration and vocalization in the periaqueductal grey is assumed, which is controlled via two pathways: an emotional system that exerts excitatory control of the periaqueductal grey descending from the temporal and frontal lobes, basal ganglia and hypothalamus; and a volitional system descending from the lateral premotor cortices that can suppress laughter or crying. To test whether the positive and negative PLC subnetworks identified in our analyses can indeed be related to an emotional system and a volitional system, we identified lesions causing emotional (n = 15) or volitional facial paresis (n = 46) in a second literature search. Patients with emotional facial paresis show preserved volitional movements but cannot trigger emotional movements in the affected hemiface, while the reverse is true for volitional facial paresis. Importantly, these lesions map differentially onto the PLC subnetworks: the 'positive PLC subnetwork' is part of the emotional system and the 'negative PLC subnetwork' overlaps with the volitional system for the control of facial movements. Based on this network analysis we propose a two-hit model of PLC: a combination of direct lesion and indirect diaschisis effects cause PLC through the loss of inhibitory cortical control of a dysfunctional emotional system.

Recognizing Early Regulation Disorders in Pediatric Care: The For Healthy Offspring Project.

BACKGROUND Regulation disorders are already apparent in infancy. The For Healthy Offspring Project was the first Hungarian study aimed at building an effective model for screening and examining the prevalence and complex (medical and psychosocial) background of classic behavior regulation disorders (excessive crying, feeding, and sleep problems) in infancy. MATERIAL AND METHODS Data were collected from families of 0- to 3-year-old children in a pediatric hospital and its neighboring areas through questionnaires, medical examinations, and individual and small-group consultations. RESULTS In the questionnaire study about their children's behavior (n=1133), 15% of mothers reported excessive crying, 16% reported feeding problems, and 10% reported sleep problems. In a subsample (n=619) in which medical examinations were also conducted, the prevalence of medical diagnoses was 15.0% for excessive crying, 15.2% for sleep disorders, 10.3% for breastfeeding difficulties, and 14.8% for feeding disorders. Children who were referred to the screening program (n=183) had significantly more behavior regulation disorders than the other children in our study. Regulation disorders were found to be comorbid with other health conditions in some cases. CONCLUSIONS We developed a complex model to screen for regulatory problems in early childhood. This study adds more information about the relationship between regulation problems and other health conditions. The general incidence (5-15%) of early childhood regulation disorders in other countries is likely similar to that found in Hungary. In order to effectively recognize early regulation disorders, diagnostic instruments widely used in the international field should be adapted in general Hungarian pediatric care.

Effects of a nine-strain bacterial synbiotic compared to simethicone in colicky babies - an open-label randomised study.

The aim of the study was to determine effects of administration of simethicone and a multi-strain synbiotic on the crying behaviour of colicky babies. The study design consisted of an open-label, two parallel treatment group study involving 87 infants aged 3-6 weeks with infantile colic (defined as crying episodes lasting 3 or more hours per day and occurring at least 3 days per week within 3 weeks prior to enrolment) randomly, unequally [1:1.5] assigned to receive simethicone (n=33) or a multi-strain synbiotic (n=54) orally for 4 weeks. The multi-strain synbiotic contained Lactobacillus acidophilus LA-14, Lacticaseibacillus casei R0215, Lacticaseibacillus paracasei Lp-115, Lacticaseibacillus rhamnosus GG, Ligilactobacillus salivarius Ls-33, Bifidobacterium lactis Bl-04, Bifidobacterium bifidum R0071, Bifidobacterium longum R0175 and fructooligosaccharides). Primary outcome measures were the responder rates (effect ≥50% reduction from baseline) of the measures 'crying days last 3 weeks', 'average evening crying duration last 3 weeks' and 'reduction of average number of crying phases per day last three weeks' at the end of treatment. The study is registered at ClinicalTrials.gov under NCT04487834. Significantly higher responder rates (effect ≥50% reduction from baseline) of the multi-strain synbiotic compared to simethicone were found for the measures 'crying days last 3 weeks' (72% vs 18%, P<0.0001) and 'average evening crying duration last 3 weeks' (85% vs 39%, P=0.0001). No significant difference was found for the measure 'reduction of average number of crying phases per day last three weeks' (50% vs 42%, P=0.4852). No adverse effects were reported for the two treatment groups. Based on these results, the multi-strain synbiotic can be considered as an interesting therapeutic possibility for the treatment of infantile colic, worthwhile to be investigated further in non-clinical and clinical studies.

Melody complexity of infants' cry and non-cry vocalisations increases across the first six months.

In early infancy, melody provides the most salient prosodic element for language acquisition and there is huge evidence for infants' precocious aptitudes for musical and speech melody perception. Yet, a lack of knowledge remains with respect to melody patterns of infants' vocalisations. In a search for developmental regularities of cry and non-cry vocalisations and for building blocks of prosody (intonation) over the first 6 months of life, more than 67,500 melodies (fundamental frequency contours) of 277 healthy infants from monolingual German families were quantitatively analysed. Based on objective criteria, vocalisations with well-identifiable melodies were grouped into those exhibiting a simple (single-arc) or complex (multiple-arc) melody pattern. Longitudinal analysis using fractional polynomial multi-level mixed effects logistic regression models were applied to these patterns. A significant age (but not sex) dependent developmental pattern towards more complexity was demonstrated in both vocalisation types over the observation period. The theoretical concept of melody development (MD-Model) contends that melody complexification is an important building block on the path towards language. Recognition of this developmental process will considerably improve not only our understanding of early preparatory processes for language acquisition, but most importantly also allow for the creation of clinically robust risk markers for developmental language disorders.

Infant Regulation: Associations with Child Language Development in a Longitudinal Cohort.

OBJECTIVE: To determine whether infants who have regulatory problems (eg, sleeping, crying, and feeding problems) at 1 year of age are at increased risk of experiencing language difficulties at ages 5 and 11 years, compared with settled infants. STUDY DESIGN: Parent survey and child assessment data (n = 1131) were drawn from a longitudinal community cohort study. Latent Class Analysis identified 5 profiles of infant regulation including those who were settled (37%), had tantrums (21%), had sleep problems (25%), were moderately unsettled (13%), and severely unsettled (3%) at 12 months of age. Adjusted regression analyses examined associations between infant regulatory profiles and language ability (Clinical Evaluation of Language Fundamentals-fourth edition) at ages 5 and 11 years. RESULTS: Infants who were moderately unsettled had lower language scores at age 5 (adjusted mean difference, -3.89; 95% CI, -6.92 to -0.86) and were more likely to have language difficulties (aOR, 2.71; 95% CI, 1.28-5.75), than infants who were settled. Infants who were severely unsettled at 12 months of age, had lower language scores at ages 5 (adjusted mean difference, -7.71; 95% CI, -13.07 to -2.36) and 11 (adjusted mean difference, -6.50; 95% CI, -11.60 to -1.39), than infants who were settled. Severely unsettled infants were 5 times more likely to have language difficulties at age 5 than their settled counterparts (aOR, 5.01; 95% CI, 1.72-14.63). CONCLUSIONS: Children at 1 year of age with multiple regulatory problems are at an increased risk for poorer language skills at ages 5 and 11 years.

The neural correlates of paternal consoling behavior and frustration in response to infant crying.

Human fathers often form strong attachments to their infants that contribute to positive developmental outcomes. However, fathers are also the most common perpetrators of infant abuse, and infant crying is a known trigger. Research on parental brain responses to infant crying have typically employed passive listening paradigms. However, parents usually engage with crying infants. Therefore, we examined the neural responses of 20 new fathers to infant cries both while passively listening, and while actively attempting to console the infant by selecting soothing strategies in a video game format. Compared with passive listening, active responding robustly activated brain regions involved in movement, empathy and approach motivation, and deactivated regions involved in stress and anxiety. Fathers reporting more frustration had less activation in basal forebrain areas and in brain areas involved with emotion regulation (e.g., prefrontal cortex and the supplementary motor area). Successful consolation of infant crying activated regions involved in both action-outcome learning and parental caregiving (anterior and posterior cingulate cortex). Overall, results suggest that active responding to infant cries amplifies activation in many brain areas typically activated during passive listening. Additionally, paternal frustration during active responding may involve a combination of low approach motivation and low engagement of emotion regulation.

Infant microbiota in colic: predictive associations with problem crying and subsequent child behavior.

Infant colic is a condition of unknown cause which can result in carer distress and attachment difficulties. Recent studies have implicated the gut microbiota in infant colic, and certain probiotics have demonstrated possible efficacy. We aim to investigate whether the intestinal microbiota composition in infants with colic is associated with cry/fuss time at baseline, persistence of cry/fuss at 4-week follow-up, or child behavior at 2 years of age. Fecal samples from infants with colic (n = 118, 53% male) were analyzed using 16S rRNA sequencing. After examining the alpha and beta diversity of the clinical samples, we performed a differential abundance analysis of the 16S data to look for taxa that associate with baseline and future behavior, while adjusting for potential confounding variables. In addition, we used random forest classifiers to evaluate how well baseline gut microbiota can predict future crying time. Alpha diversity of the fecal microbiota was strongly influenced by birth mode, feed type, and child gender, but did not significantly associate with crying or behavioral outcomes. Several taxa within the microbiota (including Bifidobacterium, Clostridium, Lactobacillus, and Klebsiella) associate with colic severity, and the baseline microbiota composition can predict further crying at 4 weeks with up to 65% accuracy. The combination of machine learning findings with associative relationships demonstrates the potential prognostic utility of the infant fecal microbiota in predicting subsequent infant crying problems.

Emotion context insensitivity in depression: Toward an integrated and contextualized approach.

Major depressive disorder (MDD) is characterized by pervasive mood disturbance as well as deficits in emotional processing, reactivity, and regulation. There is accumulating evidence that MDD is characterized by emotional patterns consistent with environmental disengagement, as reflected in attenuated positive and negative emotional reactivity, consistent with Emotion Context Insensitivity (ECI) theory. However, MDD individuals vary considerably in the extent to which they exhibit specific alterations in patterns of emotional responding. Emotions are complex, multicomponent processes that invoke responses across multiple functional domains and levels of analysis, including subjective experience, behavior, autonomic regulation, cognition, and neural processing. In this article, I review the current state of the literature on emotional responding and MDD from the lens of ECI. I focus on the importance of assessing emotional indices from multiple levels of analysis across development and contexts. I also discuss methodological and measurement issues that may contribute to inconsistent findings. In particular, I emphasize how psychophysiological measures can help elucidate emotional processes that underlie the pathophysiology of MDD as part of an integrated and contextualized approach.