Mood Repair: The Behavioral Response

There is accumulating evidence that children and adolescents at high familial risk for depression differ from typical youth in their everyday emotion experi- ences.^60,61 For example, young offspring at high risk for depression (typically due to their parental histories of depression) display lower levels of positive affect⁶² and lower rates of other indices of hedonic capacity compared to low-risk peers.⁶³ Impaired emotion regulation, posited as another affective risk factor for depression,⁶⁴ has been documented among adults and adolescents recovered from depression and youth at familial risk for depression.^60,61,65

The emotion regulation impairment that has been studied most extensively in depressed and depression-prone juveniles and young adults is mood repair.

This term refers specifically to the process of reducing or overcoming sadness and distress.^66-68 It has been proposed that, whether a given emotion regulation strategy is regarded as good or bad, helpful or not, adaptive or maladaptive, is context dependent.¹⁹ However, when focusing on the regulation of dysphoria in clinical depression, it is reasonable to assume that regulatory responses, which allow a youth to attenuate sadness, are functionally adaptive (and should be so in the long run), whereas responses that maintain or exacerbate that affect are maladaptive. Responding to sadness and distress by seeking parental (physical or verbal) comfort,⁶⁹ engaging in physical exercise,⁷⁰ and refocusing attention away from the distress experience⁷¹ are examples of adaptive mood repair responses because they attenuate sadness. Being preoccupied with and mulling over one’s feelings of misery, its causes, and implications (rumination)^72,73 and becoming behaviorally passive or socially withdrawn in distress-provoking situations⁷⁴⁷⁵ are examples of maladaptive mood repair responses because they invariably prolong sadness.

Importantly, the ability to self-regulate distress emerges in mid to late infancy and becomes fine-tuned during childhood.^20,21 Furthermore, evidence that infants at high familial risk for depression are less successful than control infants in using a particular regulatory response to reduce distress⁷⁶ suggests that mood repair problems constitute a developmentally early marker of high depression risk. Our research group has examined mood repair in various samples: young children and adolescents at familial risk for depression because they have parents or siblings with histories of depression, clinically referred youths with MDD, and young adults with histories of JOD. We assessed mood repair in several ways: ratings provided by adults or parents about themselves and about their children, reports of youngsters about themselves (which index habitual responses in daily life), laboratory observations of how young children respond to experimentally induced distress, and the subjective benefits reported by adolescents after they implemented well-established mood repair strategies in the laboratory.

We found that, in response to negative affect triggers, 4- to 7-year-old children at high familial risk for depression display maladaptive mood repair responses such as behavioral passivity and focusing of attention on the cause of distress.⁷⁷ Paralleling these observations, parental reports indicate that 6- to 13-year-old high-risk offspring have larger repertories of maladaptive mood repair responses and smaller repertories of adaptive responses than do normal peers.⁷⁸ Children and young adolescents with major depression themselves report higher rates of maladaptive mood repair response use and lower rates of adaptive response use in daily life than do normal controls.³⁶ These non-normative mood repair patterns persist years later and characterize older adolescents remitted from depression as well as their high-risk siblings who never had depression.⁷⁹ Moreover, we found that, compared to controls, depressed adolescents reaped fewer subjective benefits from implementing well-established adaptive mood repair responses in the laboratory after negative mood induction.⁸⁰

The extensive maladaptive mood repair response sets that characterize depression-prone individuals persist beyond the adolescent years. Young adults who had experienced JOD continued to report higher rates of maladaptive mood repair than did age-matched controls, and maladaptive mood repair predicted onset of a new depression episode above and beyond traditional predictors of recurrence.⁶⁵ Maladaptive mood repair also was found to predict a recurrent episode of MDD in a clinical sample of older adolescents with depression histories.⁸¹ All in all, the various assessment methods yielded convergent evidence of problematic mood repair across the pediatric and adult years in high-risk but never depressed and in currently or previously depressed youths and young adults. Although this conclusion is based on findings from our program of research, it is echoed by the available (although scant) results of other investigators.⁶¹