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Style file version June 25th, 2002

C 2003) Journal of Psychopathology and Behavioral Assessment, Vol. 25, No. 1, March 2003 (°

A Negative Mood Induction Procedure With Efficacy Across Repeated Administrations in Women Suzanna Hernandez,1 Jillon S. Vander Wal,1,2 and Bonnie Spring1 Accepted September 28, 2002

Although several experimental techniques are effective in inducing negative mood, none has established efficacy over repeated testing. The lack of mood induction tools validated across repeated administrations impedes study of emotional changes in the same individual over time. A brief, sad mood induction combining music and an autobiographical memory was administered to 17 women on 6 occasions (two 3-day sets over a 2-week period of time). Mood was measured before and after the induction procedure. Repeated measures ANOVAs showed that the induction produced a large increase in POMS depression (d = 1.48) that recurred consistently across all testing days. A brief negative mood induction combining music and autobiographical memory appears suitable for use in studies that involve repeated administrations. KEY WORDS: mood induction; negative affect; depression; repeated measures.

Procedures that experimentally alter emotional state have important research and clinical applications. Mood induction has been a cornerstone of research on experimental psychopathology (Ingram & Ritter, 2000) and personality psychology (Gilboa-Schechtman, Revelle, & Gotlib, 2000; Gomez, Cooper, & Gomez, 2000). Usually, mood has served as the independent variable whose effect on a psychological process is examined. Examples include studies comparing the influence of different moods (e.g., negative vs. positive vs. neutral) on autobiographical memory, selective attention, priming, or startle responses. When the phenomenon under study is emotional regulation, however, mood becomes the dependent variable. Relevant research questions concern, for example, the effects of rumination versus distraction on depressed mood (Nolen-Hoeksema & Morrow, 1993) or the effects of nicotine versus placebo on negative mood (Kassel & Unrod, 2000). Ideally, such questions would be answered precisely and efficiently via the use of within-participants research designs in which the same participant underwent mood induction on more than one occasion while engag1 University

ing in different self-regulatory strategies to determine the effect on mood. One barrier to such research, however, has been a lack of evidence that any mood induction procedure retains its efficacy across repeated administrations, rather than eliciting habituation or idiosyncratic response changes. To date, the lack of mood induction procedures that are validated for repeated administration has forced investigators to use between-participants designs that induce mood only one time. Several psychological procedures with established efficacy for inducing negative moods (Westermann, Spies, Stahl, & Hesse, 1996) vary in how well they appear to lend themselves to repeated administrations. Films or stories are very effective mood inducers (Gerrards-Hesse, Kordelia, & Hesse, 1994), but once the plot has been revealed, seeing a film or hearing a story for the second time is inevitably different from experiencing it initially. Another effective mood induction procedure is the Velten Protocol, in which participants read standardized positive and negative self-statements (Kenealy, 1986; Larsen & Sinnett, 1991). A difficulty with the Velten procedure, however, is that people who lack a propensity toward depressogenic ideation can self-exempt themselves from mood induction by dismissing the irrational, depressive self-statements as “silly” or “sick” (Cash, Rimm, & MacKinnon, 1986). That bias may help to account for

of Illinois at Chicago, Chicago, Illinois.

2 To whom correspondence should be addressed at Center for Health Re-

search (Room 318), Wayne State University, 5557 Cass Avenue, Detroit, Michigan 48202, 313-577-2548; e-mail: [email protected].

49 C 2003 Plenum Publishing Corporation 0882-2689/03/0300-0049/0 °


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Hernandez, Vander Wal, and Spring

some evidence indicating that recalling a sad autobiographical memory is more effective than reading a negative self-evaluation at inducing negative mood (Brewer, Doughtie, & Lubin, 1980). Listening to sad music is also an effective negative mood inducer (Clark, 1983; Martin, 1990; Slyker & McNally, 1991) and would appear to be highly repeatable. A constraint, though, is that individuals can have idiosyncratic associations to particular musical selections. To compensate for the limitations of any single technique just described, a procedure was evaluated that combines four elements that have established efficacy in negative mood induction: (a) music (Clark, 1983), (b) free mental generation of emotional state (Gerrards-Hesse et al., 1994), (c) autobiographical memories (Brewer et al., 1980), and (d) explicit instructional exhortation to “get into” the emotional state (Slyker & McNally, 1991). Participants were requested to strongly “get into” a sad mood while listening to sad music and being prompted to recall preselected sad memories. The primary objective was to determine whether the induction technique would be effective in increasing depressed mood, and whether effects would remain stable and reproducible over repeated administrations. Secondary goals were to determine what percentage of individuals were nonresponsive to this mood induction procedure in light of prior findings suggesting that 30–50% of individuals are nonresponsive to mood induction procedures (Clark, 1983; Slyker & McNally, 1991).

were scheduled during the desired time frame. The most common reason for ineligibility was having a weight that fell outside the recruitment range. Participants were paid upon study completion. Seventeen women participated in six mood induction sessions, conducted one per day over a 2-week period in two 3-day sets. Participants’ ages ranged from 18 to 42 years (M = 29.1; SD = 8.4). Nine were Caucasian, 4 were African American, 3 were Hispanic, and 1 was multiethnic. Eleven participants were single; the remainder were married or living with a partner. All had at least some college education, and the median income level was between $30,000 and $35,000.

METHOD

Structured Clinical Interview for DSM-IV, Non-Patient Version (SCID-NP)

Measures Demographics A screening sheet, which assessed the inclusion and exclusion criteria described earlier, was used to facilitate the screening of participants over the telephone. Additional demographic information, such as education, income, and ethnicity, was collected during the in-person interview. Body Mass Index (BMI; weight in kilograms per height in meters squared) was obtained by weighing study candidates after removal of heavy outer clothing and footwear and by measuring height. The inclusion criterion of “slightly to moderately overweight” was operationally defined as a BMI between 25 and 30.

Participants Data for this research were taken from a larger study evaluating women’s biological and behavioral responses to different nutrients. Participants called in response to advertisements for a women’s snacking study. Inclusion criteria for the parent study required participants to be women between the ages of 18 and 45, premenopausal, slightly to moderately overweight as defined below, and to endorse snacking on carbohydrate-based snacks (carbohydrate-toprotein ratio, 6:1) in the afternoon or evening at least 4 days per week. Participants could not be diabetic, pregnant, lactating, have food allergies, have recently lost a significant amount of weight, have severe premenstrual disturbances, be taking substances that impact mood or appetite, have a fear of blood, needles, hospitals, or have an eating disorder. Study candidates were also screened in person to confirm initial eligibility and, as described below, to rule out psychiatric conditions that could influence mood states. Of 80 initial callers, 26 were eligible and 17

Trained diagnosticians administered the Axis I modules of the SCID-NP semistructured diagnostic interview (First, Spitzer, Gibbon, & Williams, 1995; Spitzer, Williams, Gibbon, & First, 1994) to exclude candidates who currently exhibited alcohol/drug abuse, blood/needle/hospital phobias, anorexia nervosa, bulimia nervosa, major depressive disorder, severe premenstrual disturbance, anxiety disorders, or psychosis. Sad Memories Questionnaire Participants were asked to provide one-sentence descriptions of approximately 10 sad autobiographical memories. Then they rated each memory on two 10-point Likert scales to reflect (a) how sad the memory made them feel, and (b) how vividly they recalled the memory. The vividness and intensity ratings for each memory were averaged. From each participant’s pool, three different memories with the highest comparable average ratings were chosen.


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Repeatable Mood Induction Each memory was used twice—once during the 1st week of the study and once during the 2nd week of the study. Examples of memories include “the death of my younger brother in a motorcycle accident, my best friend ending our friendship, my mother calling me names.” Across participants, the average vividness rating was 7.81 (SD = 1.27) and the average intensity rating was 8.59 (SD = 1.18). Profile of Mood States (POMS) The POMS presents 65 self-descriptive adjectives that are rated on 5-point Likert scales (from 0 = not at all to 4 = extremely) to describe the participant’s mood state “right now.” The responses for the adjectives on each mood factor are summed to provide a total mood factor score. The POMS yields scores on six factors that describe a range of commonly experienced mood fluctuations: Depression, Tension, Anger, Vigor, Fatigue, and Confusion. All scales have internal consistency values ranging from .87 to .90 and evidence of construct and predictive validity (McNair, Lorr, & Droppleman, 1971). Procedure Screening In an initial telephone-screening process, women who called in response to advertisements were read a description of the entire study and asked for verbal consent to participate. Women were then screened to determine whether or not they met the inclusion or exclusion criteria. Eligible candidates were invited to an in-person screening session at which written informed consent was obtained, and the SCID-IV and Sad Memories Questionnaire were administered. Participants who remained eligible were then scheduled for the protocol. Testing only occurred between Days 7 and 21 of the menstrual cycle to minimize the influence of premenstrual affective changes. That is, no participants were tested during Days 22 and 28 (the premenstrual phase), not during Days 1 and 7 (the menstrual phase). Women were telephoned the week prior to the study to confirm menstrual cycle staging. None of the women reported having started their periods during the study when asked as a validity check. Testing Sessions Participants were tested individually. At the beginning of every session, each woman completed the POMS to characterize her baseline mood state. Then she put on earphones and began listening to a tape containing a compilation of classical music that has been shown to induce

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51 sad moods (i.e., unpleasant affect and low arousal; Eich, Macaulay, & Ryan, 1994). The music on this tape is slow in rhythm and low in tone, and it includes portions of Albinoni’s Adagio in G Minor, Barber’s Adagio pour Cades, Grieg’s Peer Gynt: The Death of Ase, Sibelius’ Violin Concerto: Second Movement, and Prokofiev’s Russia under the Mongolian Yoke. As the music began, a research assistant read aloud a standardized mood induction script. The script began, “As you can hear, there is music playing in the background. The music is to help you attain a sad mood state. I’d like you to close your eyes, listen to the music and try to remember the time when. . . .” At this point, the one sentence description of a preselected autobiographical memory was inserted into the text. Then the script resumed. “Try to really intensely get into the feelings of the music and your memory. It’s very important that you try to develop a sad mood state that is as intense and as real as you can possibly make it.” Following the instructions and memory prompt, the experimenter quietly left the room, leaving the participant to continue listening to the music and thinking about the memory for 6 min. Then the experimenter returned and asked the participant to complete a second POMS questionnaire while continuing to listen to the music. Several additional tasks for the parent study were then performed. Before leaving the laboratory for the day, the experimenter conducted a semistructured clinical interview according to the Hamilton Depression Rating Scale with the participant to ensure that her mood had returned to normal. If the score on the Hamilton was greater than 2 or the experimenter had any concerns, a positive mood induction procedure, involving listening to energetic, lively music while recalling a positive memory, was conducted. Following the positive induction, mood state was reassessed. If any concerns remained, the experimenter could page the PI or a licensed clinical psychologist for additional interventions. Participants were also given a 24-h pager number so that they could contact study personnel at any time if they felt sad. None of the participants exercised these options. The same procedure was repeated over six test days that occurred as two 3-day sets over two consecutive weeks. Data Analysis The POMS subscales were analyzed by repeated measures ANOVAs involving two within-participants factors. The time factor had two levels: pre- versus postmood induction, and the day factor had six levels: each of testing Days 1 through 6. The Simes correction (Simes, 1986), a sequentially rejective modification of the Bonferroni correction, was used to compensate for multiple comparisons.


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52 Paired samples t tests were used to determine whether the magnitude of change on the depression subscale was greater than that of the other subscales. To assess the degree to which the subscales acted as independent indicators of mood change, paired samples t tests were used to determine whether the observed change scores for each subscale were greater than would be expected, given the baseline correlations between the depression subscale and the other subscales. Criteria for an adequate response to mood inductions have often been specified arbitrarily as either a 10- or a 20-point change on a 100-point visual analogue mood scale. Because requirements for a theoretically meaningful or psychometrically equivalent change in POMS depression scores are not easily discerned, a change criterion in terms of baseline standard deviation units was specified. The number of participants who evidenced a 1 or 2 standard deviation change from baseline for each subscale was determined. Finally, Pearson product–moment correlations were computed to examine whether individual differences in the increase in sad mood brought about by the negative mood induction procedure could be characterized as showing acceptable test–retest reliability. RESULTS Results showed that the negative mood induction procedure produced significant increases in negative emotions and a significant decrease in a positive emotion from pre- to postinduction, with the repeated measures ANOVAs showing a strong main effect of time for each of the POMS subscales. After the mood induction, participants showed significant increases in POMS subscales: depression, F(1, 16) = 37.42, p < .001, η = .70, d = 1.48; confusion, F(1, 16) = 30.89, p < .001, η = .66, d = 1.35; anger, F(1, 16) = 13.91, p < .01, η = .47, d = 0.90; tension, F(1, 16) = 11.44, p < .01, η = .42, d = 0.82; and fatigue, F(1, 16) = 6.49, p < .05, η = .29, d = 0.62. There was also a significant decrease in vigor, F(1, 16) = 41.74, p < .001, η = .72, d = 1.57. Paired samples t tests showed that the magnitude of change on the Depression subscale was significantly greater than that of change on any other subscale ( ps from .03 to .001). Table I shows the average preinduction and postinduction mood scores for each of the POMS subscales. There were no significant main effects or interactions involving the day factor for any of the POMS subscales, indicating that the impact of the negative mood induction procedure remained consistent across the days of the study. Table II shows the average change in mood from preinduction to postinduction for each POMS subscale

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Hernandez, Vander Wal, and Spring Table I. Average Pre- and Postinduction POMS Subscale Scores Time

Subscale Depression Vigor Anger Fatigue Confusion Tension

Preinduction

Postinduction

X¯

SD

X¯

SD

1.63 12.11 1.53 3.74 3.79 4.38

1.79 6.81 2.51 3.06 2.73 2.53

12.33 5.47 8.20 5.12 6.48 6.45

7.57 4.32 7.76 4.81 3.56 4.04

score on each day of the study, demonstrating the reproduceability of the negative mood induction across the 6 days of the study. Paired samples t tests were used to determine whether the observed change scores were greater than would be expected, given the baseline Pearson correlations between the Depression subscale and the other subscales (vigor = −.44; anger = .78; fatigue = .55; confusion = .82; tension = .67). The differences between the expected and actual change scores were not significantly different for the vigor, t(16) = 1.97, p < .07, or anger subscales, t(16) = 1.11, p < .29. The change score for the Fatigue subscale exceeded the predicted change score, t(16) = 5.56, p < .001, whereas the change scores for the Confusion and Tension subscales were less than the expected change scores, t(16) = 5.43, p < .001, and t(16) = 5.21, p < .001, respectively. This suggests that the change scores for the Fatigue, Confusion, and Tension subscales were unlikely attributable to their correlations with the depression subscale. All participants showed at least some increase in depressed mood in response to the initial day of mood induction. The following numbers of participants (out of 17) showed at least a 1 standard deviation change from baseline mood: depression (17), vigor (7), anger (10), fatigue (3), confusion (7), and tension (7). Setting response criterion as a subscale increase of two standard deviations over baseline resulted in the following numbers of participants being classified as responders: depression (16), vigor (2), anger (9), fatigue (1), confusion (1), and tension (3). Across the 6 days of the study, test–retest correlations for the change in depression in response to sad mood induction ranged from r = .40 to r = .94, with an average correlation of .69. Two thirds of the correlations exceeded r = .6, but only one-third met the criterion (r = .8) indicative of adequate test–retest reliability. Average test–retest correlations across the 6 days of the study for the other subscales are as follows: vigor, r = .50; anger, r = .67; fatigue, r = .35; confusion, r = .45; and tension, r = .40.


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Repeatable Mood Induction

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Table II. Average Changes in POMS Subscale Scores From Pre- to Postinduction, Means, and Standard Deviations Day Subscale

Depression Vigor Anger Fatigue Confusion Tension

1

2

3

4

5

6

X¯ (SD) 9.18 (6.23) −6.71 (4.90) 3.65 (5.84) 1.06 (3.67) 1.59 (2.37) 1.18 (3.54)

X¯ (SD) 10.29 (8.28) −6.00 (3.52) 7.18 (8.03) 1.82 (4.14) 2.67 (2.61) 2.17 (3.17)

X¯ (SD) 13.35 (9.27) −8.47 (6.09) 8.00 (9.47) 2.12 (3.60) 3.71 (2.62) 2.29 (2.62)

X¯ (SD) 10.59 (9.17) −7.24 (5.88) 6.47 (10.01) 0.92 (2.59) 2.65 (2.76) 2.76 (4.01)

X¯ (SD) 9.12 (7.74) −5.59 (5.98) 7.12 (7.45) 1.12 (1.45) 2.65 (3.20) 2.12 (3.53)

X¯ (SD) 11.71 (9.31) −5.82 (6.31) 7.59 (10.38) 1.24 (3.93) 2.76 (2.68) 1.88 (4.11)

DISCUSSION Results support the efficacy as well as the repeatability of a negative mood induction procedure combining music, an autobiographical memory, and explicit instructions to “get into” the desired mood state. The availability of such a tool fills a gap in the armamentarium of research techniques that can be used to study mood regulation. The mood induction procedure generated effects that meet Cohen’s criteria for large increases in depression, anger, and confusion, as well as a large decrease in the positive affective state, vigor (Cohen, 1977). The technique also produced a moderate increase in tension and a small increase in fatigue. The magnitude of the changes on the Fatigue, Confusion, and Tension subscales is unlikely due to the correlations with the Depression subscale. Although the degree of change on the Vigor and Anger subscales was proportionate to the degree of association with the Depression subscale, it is unknown whether the changes observed were actually due to this association or to the mood induction procedure. Participants’ responsivity or sensitivity to the mood induction technique was good: all participants responded with at least a 1 standard deviation increase in depressed mood. Fewer participants manifested changes of comparable magnitude in other mood states but that was as expected, because the primary aim of the mood induction was to increase feelings of sadness. For the group of participants as a whole, mood induction effects remained remarkably consistent across six recurrent administrations. Correlational analyses showed that the degree of mood responsivity to the induction showed some consistency across individuals. However, scores did not exhibit a degree of test–retest reliability that would suggest measurement of a stable individual difference. A question can be raised concerning whether the present induction procedure (and others) trigger a genuine, as opposed to an artificial, increase in depressed mood. Might the observed mood changes signify only that participants responded to demand characteristics by

attempting to produce the response the experimenter desired (Buchwald, Strack, & Coyne, 1981)? The fact that approximately 60% of study participants show increases in depressed mood when they are simply instructed to “really get into” a sad mood, as was found by Slyker and McNally (1991) can be interpreted as evidence that demand characteristics influence responses to mood induction procedures. It is plausible, nevertheless, that the sad moods that people experience are representative of clinically meaningful depressed moods (Larsen & Sinnett, 1991). For example, the present findings show that, in addition to increasing depression, a sad mood induction increases anger and confusion. The same induction also decreases vigor. Those effects are difficult to explain on the basis of demand characteristics, because the consent process only stated that a sad mood would be induced. Participants were not told that a negative mood usually incorporates increased anger and confusion in addition to sadness—information that the average person would not be expected to know. Another question concerns whether the degree of depressed mood triggered by the present induction procedure is clinically meaningful. Studies of the external reliability and validity of mood induction responses would be advantageous. Some preliminary inferences can, nevertheless, be drawn by comparison with published findings. The mean POMS depression scale scores of outpatient psychiatric samples exceed those of demographically comparable healthy controls by an average of 9–14 points (Boyle, 1987; McNair, et al., 1971; Norcross, Guadagnoli, & Prochaska, 1984). The current mood induction procedure produced an increase in POMS depression of approximately the same magnitude (i.e., 12 points), suggesting that effects could be clinically meaningful. Moreover, the effect size associated with the change in the Depression subscale was similar to that obtained via the biological challenge technique involving tryptophan depletion, which transiently depletes brain serotonin. In a study that used the POMS as an outcome measure (Ellenbogen,


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54 Young, Dean, Palmour, & Benekelfat, 1996), tryptophan depletion triggered an increase in depression that would be characterized as a medium-sized effect (d = 0.55). In comparison, the composite psychological mood induction technique used in this study triggered a very large increase in depressed mood (d = 1.48). It can be questioned whether the negative mood induction protocol was, on the one hand, adequately standardized, and, on the other hand, adequately individualized. As is often the challenge in clinical research, the goal was to balance sufficient procedural uniformity to allow replication with adequate tailoring to engage affectively poignant personal content for each participant. Elements of the approach that were standardized across individuals included the musical selections and verbal instructions to participants. Elements that were standardized within an individual included the approximate matching of autobiographical memories chosen as prompts for a given person on imaginal vividness and affective intensity. Elements that were unique to individuals were the specific content of their sad memories. Future dismantling research is now warranted to determine whether the induction procedure can be simplified to include fewer still potent ingredients (e.g., music only, autobiographical memory, instructional exhortation). Constraints of the parent study required that the sample be limited to slightly to moderately overweight premenopausal women under the age of 45, who called in response to advertisements for a snacking study. These and the additional inclusion and exclusion criteria may limit the generalizability of the findings. The relationships between weight, gender, age, or snacking habits and mood induction responsivity are uncertain. It cannot be assumed that the induction procedure will work equally well among men, older individuals, or among persons who do not snack or that similar proportions of persons will be responsive to the procedure. Another limitation involved the use of a single outcome measure of mood. The addition of another brief instrument sensitive to state-based mood changes would bolster confidence in the results as would replication of the study with a different outcome measure with a less obvious focus on mood. In sum, the results indicate that a psychological mood induction procedure combining music and autobiographical memory generates large increases in depressed mood that can be reproduced over multiple occasions. Criteria for adequate individual responsivity to mood induction remain open to interpretation, but it can be noted that none of the participants entirely failed to respond, and that the group’s responses remained remarkably consistent over recurrent inductions. The availability of a negative mood induction procedure that shows satisfactory efficacy over


Hernandez, Vander Wal, and Spring repeated administrations opens the possibility of studying the same individuals’ management of depressed moods over time and as a function of different conditions.

ACKNOWLEDGMENTS This study was supported in part by Grant HL63307 awarded to Dr Bonnie Spring.

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Repeatable Mood Induction McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). The Manual for the Profile of Mood States (POMS). San Diego, CA: Educational and Industrial Testing Services. Nolen-Hoeksema, S., & Morrow, J. (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition and Emotion 7(6), 561–570. Norcross, J. C., Guadagnoli, E., & Prochaska, J. O. (1984). Factor structure of the Profile of Mood States (POMS): Two partial replications. Journal of Clinical Psychology, 40(5), 1270–1277. Simes, R. J. (1986). An improved Bonferroni procedure for multiple tests of significance. Biometrica, 73(3), 751–754.

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55 Slyker, J. P., & McNally, R. J. (1991). Experimental induction of anxious and depressed moods: Are Velten and musical procedures necessary? Cognitive Therapy and Research, 15(1), 33–45. Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B. (1994). The Structured Clinical Interview for DSM-IV (SCIDIV). New York: New York State Psychiatric Institute, Biometrics Division. Westermann, R., Spies, K., Stahl, G., Hesse, F. W. (1996). Relative effectiveness and validity of mood induction procedures: A meta-analysis. European Journal of Social Psychology, 26(4), 557–580.