Reactivity to Positive Emotions, Fear, and Anger in Depression and Anxiety: Gender Differences Among a Psychiatric Outpatient Sample

Background and Purpose: The purpose of this study is to identify the contribution of emotional reactivity with depression and anxiety symptoms among adults diagnosed with a serious mental illness. We also explore gender differences in emotional response as they relate to psychiatric distress, as females are more frequently diagnosed with affective disorders. The importance of emotional processing in therapy is recognized across different theoretical perspectives (e.g., psychoanalytic, cognitive behavioral; Pos, et al., 1993). Reduced reactivity to both negative and positive cues is associated with depression (Bylsma, Morris, & Rottenberg, 2008), and greater emotional arousal is associated with anxiety (Mennin, Heimberg, Turk, & Fresco, 2005). We hypothesize that reduced reactivity to positive emotions will most strongly relate to depression, while reactivity to fear and anger will more strongly covary with anxiety symptoms. We also hypothesize that in the context of anxiety, men will endorse greater reactivity to anger, and females will express lower reactivity to positive emotional cues.

Methods: Cross-sectional data were collected from intensive case management service recipients (n = 150) at a community mental health center. Emotional numbing and reactivity were measured using the Emotional Numbing and Reactivity Scale (ERNS; Orsillo, et al., 2007). Depression was measured using the Patient health Questionnaire-9 (PHQ-9), and anxiety using the Generalized Anxiety Disorder-7 scale (GAD-7). Hierarchical multiple regression was conducted to identify the contribution of self-rated emotional response to positive, fear, and anger cues to depression and anxiety. First, emotional response was entered, then gender, and finally the interaction of gender with each emotional response variable.

Results: The primarily male (53.2%) and African-American (60.4%) sample reported a mean age of  58.29 years (SD=5.83). The PHQ-9, GAD-7, and ERNS sub-scales all had acceptable internal consistencies (α=.77 to .92). Moderate levels of depression (M=8.85, SD=6.98) and anxiety (M=7.53, SD=6.78) were reported, with females reporting higher depression (p<.05) and anxiety (p<.01) symptoms. In the first step, emotional response variables all significantly contributed to the depression (F(3,133)=13.65,p<.001, R²=.235) and anxiety (F(3,135)=22.19,p<.001, R²=.284). In the second step, gender explained an additional 3.08% (p<.05) of variance in depression and 5.58% (p<.05) of variance in anxiety.  In the final step for depression,  no significant interaction of gender and emotional response was observed (ΔR²=.0053, p>.05). In the final step for anxiety, female gender significantly interacted with positive emotions to predict anxiety symptoms (B=-.192, p=.042); however, this explained only an additional 1.9% of the variance (p>.05).

Conclusions and Implications: Depression and anxiety were associated with decreased reactivity to positive cues and increased reactivity to negative cues. Female gender was associated with greater self-reported psychiatric distress; however, emotional response generally did not interact with gender to amplify distress. Restricted or excessive emotional response may impede progress in therapies aimed at ameliorating mood and anxiety-related disorders. Treatment may be less efficacious if client engagement with emotions is restricted or if overly active (Rauch & Foa, 2006). Clinicians may need to tailor interventions for depression and anxiety according to consumers’ emotional response styles to promote emotional engagement in therapy.