Brief Report

MOOD INDUCTION WITH FACIAL EXPRESSIONS OFEMOTION IN PATIENTS WITH GENERALIZED ANXIETY

DISORDER

Shikha Srivastava, Ph.D.,1 Hari O. Sharma, Ph.D.,2 and Manas K. Mandal, Ph.D.,2n

Patients with general anxiety disorder (GAD), anxiety prone subjects, andnormal controls (n¼ 30, N¼ 90) were subjected to happy and sad moodinduction conditions using facial expressions of emotion of varied intensity.Following mood induction, subjects were required to judge their mood state ontwo scales: the Positive and Negative Affect Scale and the Emotional Self RatingScale. In general, the anxiety groups showed more sensitivity to the sad moodinduction condition. However, the anxiety groups had a higher subjective ratingfor positive than negative emotions during the happy mood induction condition.These findings suggest the efficacy of the mood induction procedures in anxietydisorders. Depression and Anxiety 18:144–148, 2003. & 2003 Wiley-Liss, Inc.

Key words: mood induction; facial expression; emotion; anxiety

INTRODUCTION

Mood induction procedures are extensively used inexperimental research on emotion. A variety ofprocedures are reported in the literature including freemental generation of emotional states, presentation ofemotion inducing materials, presentation of needrelated emotional stimulations, and generation ofemotionally relevant physiological states [for a review,see Gerrards-Hesse et al., 1994]. Gerrards et al. [1994]reviewed 96 studies that utilized mood inductionprocedures that demonstrated the validity of suchmethods in inducing elation and depression in normalsubjects. These studies, with the exception of a few,were not generally on conditions like anxiety ordepression. For example, Pine et al. [2001] found thatthe subjective experience of fear (such as fear ofdarkness) in adolescents predicted future risk or majordepression. In an fMRI study, Sheline et al. [2001]documented increased left amygdala activation, espe-cially for fearful faces. In a different study, subjectiveanxiety was induced with the use of an aversive stimulusto adults and fMRI signals suggested the role of theamygdala in fear conditioning [Pine et al. 2001].

The present study was an attempt to examine theefficacy of mood induction procedures on anxietyconditions in order to evaluate a) the relevance of theprocedure in ascertaining the psychopathologicalstatus, and b) the efficacy of the procedure in

therapeutic interventions. We examined the subjectiveresponse pattern of induced emotional states (positiveand negative) in patients with generalized anxietydisorder (GAD), anxiety prone subjects, and normalcontrols. An attempt was also made to ascertain theemotion recognition ability in these groups, sincemood induction procedures are contingent upon theability to recognize emotions accurately. To pursuethese aims, subjective mood was induced by asking thesubjects to observe emotions depicted in facial expres-sions. The method was found powerful for generationof emotional states as a function of ‘‘primitiveemotional contagion’’ [Hatfield et al., 1995; see Wildet al., 2001]. Face perception was found to be mediatedby a distributed neural system [Haxby et al., 2000], andthe face-viewing condition in fMRI studies revealed

DEPRESSION AND ANXIETY 18:144–148 (2003)

1BanarasHindu University, Varanasi, India2Indian Institute of Technology, Kharagpur, India

nCorrespondence to: Dr. Manas K. Mandal, Department of

Humanities and Social Sciences, Indian Institute of Technology,

Kharagpur 721302, India. E-mail: mkm@hss.iitkgp.ernet.in

Received for publication 30 September 2002; Accepted 17 July

2003

DOI 10.1002/da.10128

Published online in Wiley InterScience (www.interscience.wiley.

com).

&& 2003 WILEY-LISS, INC.

distinct activation in the brain, implying the paradigm’sefficacy in the generation of mood [Haxby et al., 2001].Therefore, it was hypothesized that a) GAD patientswould be significantly inferior to anxiety prone ornormal subjects in recognition of facial expressions ofemotion, and b) subjective ratings following experi-mental mood induction would dif ferentiate anxietygroups from normal subjects.

SUBJECTS AND METHODS

SUBJECTS

GAD patients (n¼ 30, mean age 24.5 years, sd 6.75years; mean education 15.2 years), anxiety pronesubjects (n¼ 30, mean age 21.9 years, sd 3.45 years;mean education 15.9 years), and normal controls(n¼ 30, mean age 23.2 years, sd 1.95 years; meaneducation 16.5 years) were requested to volunteerfor the experiment after obtaining the requisiteconsent. GAD patients were clinically diagnosedaccording to the criteria of DSM IV [AmericanPsychiatric Association, 1994] by the treating psychia-trists, and these patients did not have comorbiddepressive disorder. Patients received medicine duringthe study and none of them were hospitalized. Anxietyprone subjects were neither hospitalized nor receivingany treatment and were selected from a largersample (N¼ 295) who were subjected to assessmentof anxiety symptoms. The level of anxiety for subjectswas assessed using the Hindi adaptation of State–Trait Anxiety Inventory, STAI [Spielberger et al.,1973]. (The correlation of the original version of STAI[Spielberger et al., 1970] and the Hindi adaptation was.846.) These subjects had a high score on the State–Trait Anxiety Inventory (A-State: mean 51.76, sd 7.95;A-Trait: mean 56.16, sd 14.06). Subjects, considered asanxiety prone, had their mean anxiety score above(1 sd ) the normal range (A- State: mean 49.95, sd 7.33;A- Trait: mean 52.4, sd 6.46). Normal controls hadtheir anxiety scores within the normative limits (7 1sd ) of the distribution (A-State: mean 33.24, sd 8.63;A-Trait: mean 33.67, sd 8.74). Anxiety prone subjectsand normal controls underwent further screeningfor medical, neurological, and psychiatric disorders,and were found healthy, not on medication,and without a history of DSM IV [APA, 1994]disorders in first degree relatives, as indicated by theparticipants.

TOOLS

The PENN Facial Discrimination Test was used forexamining subjects’ ability to recognize positive andnegative emotions. Stimuli included 20 neutral, 10happy, and 10 sad ‘‘black and white’’ facial expressions,with equal number of male and female faces in eachcategory. The construction and standardization offacial stimuli were detailed elsewhere [Erwin et al.,1992; Schneider et al., 1994]. Subjects were required to

rate their induced mood on the Positive and NegativeAffect Scale (PANAS) [Watson et al., 1988]. PANAS isa five-point unipolar intensity scale that includesratings for emotional dimensions from positive tonegative (1-not at all to 5-extremely). Subjects werealso required to rate their feelings on six emotioncategories (anger, fear, disgust, happiness, sadness, andsurprise) using a five-point unipolar intensity scale[Emotional Self Rating (ESR: 1¼ not at all,5¼ extremely)]. These scales (PANAS and ESR)required subjects to rate how they actually felt whilewatching the slides. The ESR scale was administered tovalidate the dimensional judgments on the PANASscale along with the indication for emotion category-specific mood.

PROCEDURE

The experiment was conducted in two phases: 1)PENN Facial Discrimination Task and 2) MoodInduction Task. Subjects were tested individually afteradministering the Hindi version of the State–TraitAnxiety Inventory [Spielberger et al., 1973]. For theFacial Discrimination Task, subjects were asked to vieweach photograph and judge whether the facial expres-sion was happy, sad, or neutral. If the facial expressionwas happy or sad, subjects were required to rate theintensity of expressed emotion using a seven-pointbipolar scale (e.g., 1¼ very happy, 4¼ neutral, and7¼ very sad).

During the mood induction procedure, subjects wereinstructed to carefully observe slides that depictedfacial expressions of emotions of varied intensity. Theywere further instructed to observe as long as theyneeded to achieve the emotional state depicted. Whenthe subjective change in mood was experienced,subjects indicated their readiness to view the next slide.Subjects were asked to achieve the emotional stateeither by ‘‘imagining what would make the person onthe slide express the emotion’’ or ‘‘by conceiving asimilar situation that happened to the subject in his/herlife’’ [Schneider et al., 1995]. The standard instructionswere ‘‘during this task, I would like you to try tobecome happy [sad]. To help you do that, I will beshowing you slides with faces expressing happiness[sadness]. Look at each face and use it to help you tofeel happy [sad]’’ [see Habel et al., 2000]. Subjects wereasked to rate their feeling/emotion during the task onfive-point scales of PANAS and ESR.

RESULTSPENN FACIAL DISCRIMINATION TASK(PFDT)

Data were analyzed using a signal detection para-digm. Sensitivity and response criterion for thesegroups were as follows: normal controls: d0 ¼ 2.69,b¼ .43; anxiety prone subjects: d0 ¼ 2.51, b¼ .37; andGAD patients: d0 ¼ 1.21, b¼ 1.65 (see Table 1). These

Brief Report: Mood Induction and Anxiety 145

findings indicated an individual observer’s sensitivitytoward facial expressions. Facial stimuli were recog-nized correctly beyond chance by groups, and thediscrimination between emotional and neutral stimuliwas not due to chance. Subjects of all groups weregenerally able to judge neutral and facial emotionalstimuli. Judgments of normal subjects were relativelysuperior to anxiety prone subjects or GAD patients; thegroup dif ference was however nonsignificant.

MOOD-INDUCTION TASK

Data were analyzed separately for two dependentmeasures: the PANAS and the ESR.

PANAS. These data (Table 2) were analyzed with a 3(Groups)� 2 (Mood states)� 2 (Emotions) mixedfactorial ANOVA with repeated measures in the Moodstate and Emotion factors. The main effects of Group[normal controls: mean 2.48, anxiety prones: mean1.37, GAD patients: mean 1.42) (F(2, 87)¼ 2.99,Po.05)] and Emotion [positive affect: mean 2.41,negative affect: mean 2.04) (F(1, 87)¼ 8.09; Po.006)]were significant but not the main effect of Mood [F(1,87)¼ .205 Po.05]. The interaction of Group�Moodstate [F(2, 87)¼ 9.88, Po.001] was significant. GADpatients had significantly higher ratings for the sadmood induction condition as compared to the anxietyprone group (Po.05) and normal control group(Po.01) group [F(2, 87)¼ 12.87, Po.01]. On the otherhand, normal controls had significantly higher ratings

for the happy mood induction condition followed bythe anxiety prone group (Po.05) and the GAD patients(Po.01) [F(2, 87)¼ 12.26, Po.01]. The two-wayinteractions of Mood�Emotion [F(2, 87)¼ 2.93,Po.01] and Group�Emotion [F(2, 87)¼ 28.0,Po.001] were also significant. The three-way interac-tion of Group�Mood�Emotion did not reach thetraditional level of significance [F(2, 87)¼ 2.93,P¼.059].

ESR. These data (Table 3) were analyzed with a 3(Groups)� 2 (Mood states)� 6 (Emotions) factorialANOVA with repeated measures in Mood and Emo-tion factors. Analysis of data revealed that the maineffects of Mood [F(1, 81)¼ 35.29, Po.001] andEmotions [F(5, 435)¼ 42.74, Po.001] were significant.The main effect of Group was not significant [F(2,87)¼ 2.34, Po.05].

The interaction of Group�Mood was significant[F(2, 87)¼ 6.08, Po.003]. While the ESR rating afterhappy mood induction had a nonsignificant groupdifference, the ratings after sad mood induction werehigher for GAD patients in comparison to the anxietyprone group (Po.05) and normal controls (Po.01)[F(2, 87)¼ 5.84, Po.01]. The two-way interactions ofGroup�Emotion [F(10, 435)¼ 5.25, Po.003] andMood�Emotion [F(5, 435)¼ 103.73, Po.001] weresignificant. The three-way interaction of Group-�Mood�Emotion was also significant [F(10,435)¼ 2.42, Po.05].

DISCUSSIONThe primary purpose of administering the PENN

Facial Discrimination Task was to ensure that thedifference in effectiveness of mood-induction proce-dures was not attributable to difficulties in emotiondiscrimination or facial expressions of dif ferent culturalorigin (North American). It has been observed that

TABLE 1. Recognition of facial expressions of emotionsin three groups

ResponseaNormalcontrol

Anxietyprone GAD

Hit .95 .94 .70False alarm .15 .20 .25Miss .05 .06 .30Correct rejection .85 .80 .75d0 2.69 2.51 1.21b .43 .37 1.65

ad0, sensitivity index.b=criterion index; GAD=generalized anxiety disorder.

TABLE 2. Positive and Negative Affect Scale (PANAS)during mood induction

Inducedmood Emotion

Normalcontrol

Anxietyprone GAD

Happy Positive 4.28 (0.90) 2.85 (0.69) 2.01 (0.35)Negative 1.32 (0.30) 1.52 (1.09) 1.58 (0.44)

Sad Positive 2.18 (0.57) 1.78 (0.39) 1.41 (0.30)Negative 2.17 (0.57) 2.06 (0.57) 3.63 (0.63)

Mean (sd ) scores are reported. 1¼ not at all, 5¼ extremely.N=90 subjects; n=30 for each group.

TABLE 3. Emotional Self Rating (ESR) during moodinduction

Inducedmood

Emotioncategory

Normalcontrol

Anxietyprone GAD

Happy Anger 1.23 (0.56) 1.23 (0.50) 1.16 (0.46)Disgust 1.53 (0.73) 1.13 (0.34) 1.40 (0.62)Fear 1.33 (0.80) 1.11 (0.30) 1.27 (0.44)Happy 3.20 (1.03) 2.73 (1.11) 2.10 (0.84)Sad 1.33 (0.60) 1.53 (0.86) 1.57 (0.62)Surprise 1.76 (0.72) 1.40 (0.56) 1.46 (0.81)

Sad Anger 1.63 (0.56) 1.66 (0.50) 1.77 (0.46)Disgust 1.90 (1.06) 1.30 (0.65) 1.83 (0.91)Fear 1.67 (0.60) 1.83 (0.87) 2.60 (1.07)Happy 1.16 (0.59) 1.40 (0.89) 1.13 (0.50)Sad 3.23 (0.93) 3.60 (0.98) 3.70 (1.11)Surprise 1.53 (0.77) 1.46 (0.68) 1.33 (0.60)

Mean (sd ) scores are reported. 1¼not at all, 5¼ extremely.N=90 subjects; n=30 for each group.

Srivastava et al.146

facial expressions of basic emotions like happy or sadare recognized universally [Ekman, 1984]. Earlierstudies of North American facial expressions haveshown cross-cultural equivalence for Indian observers[Mandal et al., 1996]. Cultural interference was alsofound to be minimal in a mood induction study thatused extra-cultural facial expressions in patients withschizophrenia [Weiss et al., 2000]. The present findingsuggested that recognition of facial expressions isaccurate (in terms of sensitivity and specificity) for allgroups, though the sensitivity was highest for normalcontrols, followed by anxiety prone subjects and GADpatients.

The mood induction procedure that used emotionalfacial expressions was found reliable in the presentstudy, as established earlier by Schneider et al. [1994]on normal subjects and schizophrenic patients [Weisset al., 2000]. The rationale behind this assertionwas based on subjects’ rating for PANAS and ESR.The face-viewing paradigm was consistent with thepurpose of mood induction, as documented in fMRI[Haxby et al., 2001; Sheline et al. 2001] and otherstudies [Pine et al., 2001; Wild et al., 2001]. Thecurrent results show that subjects rated themselves ashaving more positive than negative mood following thepresentation of happy emotional expressions and ashaving more negative than positive mood following thepresentation of sad emotional expressions. Despite thisfinding, the inter-group variability was quite distinc-tive. The two-way interaction effects of Group-�Mood on PANAS and ESR scales indicated thatthe effect size was significantly higher for the sad moodinduction condition in anxiety groups than in normalcontrols. In contrast, the effect size was significantlyhigher for the happy mood induction condition innormal controls than in anxiety groups. It appearedthat the sad mood could be more easily induced inanxiety groups using negative mood induction condi-tion. The happy mood, on the other hand, could bemore easily induced in normal controls using positivemood induction condition. Comparatively, the PANASscale was found to be a more sensitive measure than theESR scale. This may be partly attributable to responsealternatives of the two outcome measures. WhilePANAS required a dimensional (positive–negative)judgment, ESR required a finer categorical judgment(happy, sad, fear, etc.).

Our findings, however, do not nullify the possibilityof inducing positive mood in anxiety groups usingmood induction procedures. This fact has beenestablished by the observation that anxiety groupshad higher ratings for positive emotions than negativeemotions during the happy mood induction condition(see PANAS rating, Table 2). In fact, the groupdif ference for ratings of negative emotions during thehappy mood induction condition was nonsignificant.The group difference was significant for ratings ofpositive emotions during the sad mood inductioncondition.

The effect sizes following happy and sad moodinductions were consistent with the level of anxiety.Patients with generalized anxiety disorder showedmore specificity to happy and sad mood inductionconditions in comparison to anxiety prone subjects.

Acknowledgments. This article is based partlyon the doctoral dissertation of the first authorsubmitted to Banaras Hindu University, Varanasi,India. Authors thankfully acknowledge the helpof Professor F. Schneider for providing the requisitematerials and comments on an earlier version of thepaper.

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