An Experimental Paradigm for Triggering a Depressive Syndrome

Altman, M., Martin, L. W., Chiu, C., Northover, S. B., Huang, S., Goegan, S., Maslej, M. M., Hollon, S. D., Mulsant, B. H., & Andrews, P. W. (2024). An experimental paradigm for triggering a depressive syndrome. Emotion, 24(6), 1442–1455. https://doi.org/10.1037/emo0001338

Rationale

Experimental research on depression has been limited by a lack of paradigms that can test causal relationships and induce a broader depressive syndrome beyond just sad mood (Kuehner et al., 2007).

Most studies rely on correlational or case-control methods (Fazel et al., 2008; Newton-Howes et al., 2006; Rich & Scovel, 1987).

While stressors are thought to cause depressive episodes, this has only been studied correlationally (Kessler, 1997).

Variability in depressive symptoms may reflect differences in triggering stressors, but this too has only been examined with correlational methods (Keller et al., 2007; Keller & Nesse, 2006).

Establishing experimental control over multiple depressive symptoms can enable stronger causal inferences and improve understanding of the etiology of depression, which is currently not well understood (Saveanu & Nemeroff, 2012).

This study aimed to develop a paradigm to induce core psychological symptoms of depression in a controlled setting. A previous pilot study found their Cyberball exclusion manipulation increased sadness and decreased happiness.

Method

The study randomly assigned 134 undergraduate students to exclusion or control groups.

The exclusion group completed a guided conversation task, the Cyberball game where they were excluded, and received false feedback that no one wanted to work with them.

Controls had a fair experience. Participants completed mood measures before and after, wrote about their experience, and did a working memory task. Writings were analyzed for rumination themes.

Procedure

Participants completed questionnaires, had a guided conversation to get to know each other, were told to rank who they wanted to work with, then played Cyberball believing they were playing live with the others.

Cyberball: In their individual rooms, participants engaged in the online ball-tossing game (believing it was happening in real-time with the other participants.

However, the game was pre-programmed:

• Exclusion participants received few ball tosses and false feedback that no one chose them as a partner (they were no one’s first or second choice and would therefore be transferred to the “Solo” mode of playing)
• The inclusion (control) group received a fair distribution of tosses throughout the game and were moved to the “Solo” mode of playing under the pretense that a participant (the confederate) had to leave.

Participants reported their mood before and after, wrote for 25 minutes about their experience, then did a working memory task while holding a word list in mind.

Sample

134 undergraduate psychology students (112 female, 22 male). 28 participants reported a previous diagnosis of depression or anxiety.

Measures

• Nine-item Patient Health Questionnaire (PHQ-9): assessed depressive symptoms
• Valence-Arousal Mood Profile (VAMP): measured sadness, happiness, anxiety, calmness
• Raven’s Advanced Progressive Matrices: assessed working memory
• Writings rated for rumination themes: presence of a problem, causal analysis, self-blame, low self-esteem, counterfactuals

Statistical measures

ANOVAs compared groups on mood and working memory performance. T-tests and Mann-Whitney U compared writing ratings between groups. Correlations examined relationships between rated variables.

Results

• Prediction 1 supported: Excluded participants reported higher sadness, lower happiness, and performed worse on the working memory task compared to controls
• Prediction 2 partially supported: Analysis of participants’ writings found excluded participants showed more self-blame, low self-esteem, causal analysis, and perception of a problem, but not more counterfactual thinking.
• Prediction 3 partially supported: Excluded participants performed worse on the working memory task overall; no effect of priming condition

Insight

This study provides experimental evidence that social exclusion can trigger a cluster of depressive symptoms, not just sad mood, in otherwise healthy young adults.

The symptoms appear to center around a ruminative process involving root cause analysis of the exclusion event – excluded participants tried to causally deconstruct why it happened and blamed themselves.

This rumination seems to take up cognitive resources and interfere with non-related tasks requiring concentration.

Importantly, four core DSM symptoms of depression were induced, suggesting the criteria may pathologize some normal responses to social stressors.

The results align with evolutionary theories proposing depression promotes an analytical thinking style to understand and avoid harmful social events.

Inducing this syndrome in healthy undergraduates challenges the notion that worthlessness/guilt is inherently pathological.

Future work can use this paradigm to explore other hypotheses about depressive etiology and phenomenology.

Strengths

• An experimental design enabling causal inferences
• Random assignment to groups
• Measuring mood before and after the manipulation
• Inducing a cluster of symptoms beyond just sad mood
• Analyzing written content for depressive themes
• Testing effects on a separate cognitive task
• A non-clinical sample to examine normal vs. disordered responses

Limitations

• The study tested a brief, transient depressive state in a small non-clinical sample of mostly women. The results may not generalize to clinical depression in broader populations.
• The writing prompt focused attention on the Cyberball experience which may have inflated rumination.
• Self-report mood measures are vulnerable to demand characteristics.

Clinical Implications

Demonstrating that social exclusion can trigger a ruminative depressive syndrome in healthy young adults has implications for the boundaries between normal and disordered depression.

Current diagnostic criteria may over-pathologize responses to social stressors that are common in the population and potentially adaptive.

Psychotherapies that aim to work with the thoughts and feelings that follow stressful events, rather than suppress them, may better help individuals learn and recover from such experiences.

The stigma of being labeled disordered may deter people from such beneficial therapeutic processes. More research is needed on the function of symptom profiles and their relevance to clinical practice.

References

Primary reference

Altman, M., Martin, L. W., Chiu, C., Northover, S. B., Huang, S., Goegan, S., Maslej, M. M., Hollon, S. D., Mulsant, B. H., & Andrews, P. W. (2024). An experimental paradigm for triggering a depressive syndrome. Emotion, 24(6), 1442–1455. https://doi.org/10.1037/emo0001338

Other references

Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine, 5(12), Article e225. https://doi.org/10.1371/journal.pmed.0050225

Keller, M. C., Neale, M. C., & Kendler, K. S. (2007). Association of different adverse life events with distinct patterns of depressive symptoms. American Journal of Psychiatry, 164(10), 1521–1529. https://doi.org/10.1176/appi.ajp.2007.06091564

Keller, M. C., & Nesse, R. M. (2006). The evolutionary significance of depressive symptoms: Different adverse situations lead to different depressive symptom patterns. Journal of Personality and Social Psychology, 91(2), 316–330. https://doi.org/10.1037/0022-3514.91.2.316

Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48(1), 191–214. https://doi.org/10.1146/annurev.psych.48.1.191

Kuehner, C., Holzhauer, S., & Huffziger, S. (2007). Decreased cortisol response to awakening is associated with cognitive vulnerability to depression in a nonclinical sample of young adults. Psychoneuroendocrinology, 32(2), 199–209. https://doi.org/10.1016/j.psyneuen.2006.12.007

Newton-Howes, G., Tyrer, P., & Johnson, T. (2006). Personality disorder and the outcome of depression: Meta-analysis of published studies. British Journal of Psychiatry, 188(1), 13–20. https://doi.org/10.1192/bjp.188.1.13

Rich, A. R., & Scovel, M. (1987). Causes of depression in college students: A cross-lagged panel correlational analysis. Psychological Reports, 60(1), 27–30. https://doi.org/10.2466/pr0.1987.60.1.27

Saveanu, R. V., & Nemeroff, C. B. (2012). Etiology of depression: Genetic and environmental factors. Psychiatric Clinics of North America, 35(1), 51–71. https://doi.org/10.1016/j.psc.2011.12.001

Keep Learning

• How does this study challenge current conceptions of “normal” vs “disordered” depression? What are the implications of finding that core depressive symptoms can be induced in healthy people?
• Do you think the depressive symptoms triggered by social exclusion in this study are adaptive or maladaptive responses? Why? How could researchers test the function of the response?
• The study suggests therapies that encourage exploring painful thoughts and feelings may be more beneficial than trying to avoid or suppress them. Do you agree? What would this look like in practice?
• What other social stressors might trigger a similar depressive syndrome? How could future studies improve on this paradigm to better approximate clinical depression?
• The authors propose depression promotes an analytical thinking style focused on understanding harmful social events. What evolutionary purpose might this serve? What are the advantages and disadvantages of this cognitive style?