Positive Mood States and Gambling Disorder

Gambling problems are experienced by about 1% of the adult population, with higher estimates reported in adolescents. Both positive and negative motivations for gambling exist and may contribute to gambling problems. Positive valence disturbances involving how people process rewards, including monetary rewards relevant to gambling, have been reported in gambling disorder and have been associated with the disorder and clinically relevant measures relating to impaired impulse control. Positive valence systems as they relate to gambling disorder and clinically relevant features thereof are considered in this chapter. Findings from neuroimaging data related to the positive valence system constructs of approach motivation, initial and sustained/longer term responsiveness to reward, habit and reward learning are reviewed. Possible interactions between positive valence systems and other Research Domain Criteria (RDoC) systems are also discussed within the context of gambling disorder, as is how the application of an RDoC framework can be used to further understanding of gambling disorder.

Positive Emotion in Borderline Personality Disorder

Borderline personality disorder (BPD) is a severe form of personality pathology characterized by high levels of negative emotionality. Because negative emotions are so central to the clinical presentation of BPD, the issue of how people with this disorder process and experience positive emotional experiences is relatively unexplored. This chapter provides an overview of what is currently known about positive emotions and BPD. Although the literature is characterized by many inconsistencies, our review suggests that people with BPD do indeed experience positive emotions. However, their recall of positive emotional experiences appears to be reduced, perhaps because such experiences are more transient, less stable, and more likely to be quickly replaced by negative emotions. Problems with the identification and accurate differentiation of positive emotions may also play a role. Such difficulties may conspire to create a psychological world for people with BPD that is characterized by a focus on negative mood and negative emotional experiences. In addition to focusing on negative affect, we suggest that it might also be clinically beneficial to make problems with positive affect a specific clinical target.

Positive Emotion in Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a debilitating condition characterized by excessive, pervasive, uncontrollable, and paralyzing worries about a wide range of future situations. Individuals with this condition frequently find themselves stuck in worry and tension cycles in futile attempts at reducing uncertainty and increasing control. GAD has been associated with substantial impairments in functioning and reduced quality of life. GAD remains poorly understood, and the long-term efficacy and end-state functioning resulting from treatment are weaker compared to other anxiety disorders. Some treatments (e.g., emotion regulation therapy, acceptance-based behavioral therapy) have improved efficacy, partly by targeting emotional dysfunction. Basic psychopathology research has focused on identifying the role of negative affect in GAD, so little is known about how positive affect is experienced and regulated in this disorder. This is particularly important in light of the overlap of this condition with major depressive disorder, which is characterized by low or suppressed positive emotion. Developing such an understanding is essential to further improve the efficacy of emotion-based treatments. This chapter reviews current and future directions in the study of positive affect in GAD. The chapter reviews the nascent research on positive affect and GAD, then illustrates dimensions of future work.

Neurobiological Reward-Related Abnormalities Across Mood Disorders

This chapter provides a critical review of recent behavioral and neuroimaging evidence of reward processing abnormalities in mood disorders. The primary focus is on the neural mechanisms underlying disruption in approach motivation, reward learning, and reward-based decision-making in major depression and bipolar disorder. Efforts focused on understanding how reward-related impairments contribute to psychiatric symptomatology have grown substantially in recent years. This has been driven by significant advances in the understanding of the neurobiology of reward processing and a growing recognition that disturbances in motivation and hedonic capacity are poorly targeted by current pharmacological and psychotherapeutic interventions. As a result, numerous studies have sought to test the presence of reward circuit dysfunction in psychiatric disorders that are marked by anhedonia, amotivation, mania, and impulsivity. Moreover, as the field has increasingly eschewed categorical diagnostic boundaries in favor of symptom dimensions, there has been a parallel rise in studies seeking to identify transdiagnostic neural markers of reward processing dysfunction that may transcend disorders. The thesis of this chapter is twofold: First, evidence indicates that specific subcomponents of reward processing map onto partially distinct neurobiological pathways. Second, specific subcomponents of reward processing, including reward learning and effort-based decision-making, are impaired across different mood disorder diagnoses and may point to dimensions in symptom presentation that possess more reliable behavioral and neural correlates. The potential for these findings to inform the development of prevention and treatment strategies is discussed.

Indices and Correlates of Positive Emotion in Psychopathology

This chapter not only draws from previous authoritative measurement overviews in the general field of emotion, but also advances these resources in several key ways. First, it provides a specific focus on positive valence systems, which have not yet received specific methodological attention. Second, the field of positive emotion (PE) has expanded in recent years with new and innovative methods, making an updated review of methodological tools timely. Third, the chapter incorporates discussion of PE disturbance in clinical populations and the methods best suited to capture PE dysfunctions. This chapter also outlines some tools that can allow researchers to capture a broad array of PE quantified by self-report, behavioral coding, and biological correlates as seen through changes in the central and peripheral nervous system (i.e., brain and body). After reviewing PE measurement methods and correlates, this chapter includes several methods for studying PE beyond the individual level (i.e., interpersonal) and traditional laboratory settings (i.e., ambulatory or experience sampling). It provides key examples of their applications to study PE in clinical populations while acknowledging several of their basic advantages and disadvantages.

Protector and Casualty

Early-life adversity is associated with elevated risk for a wide range of mental disorders across the lifespan, including those that involve disruptions in positive emotionality. Although extensive research has evaluated heightened negative emotionality and threat processing as developmental mechanisms linking early-life adversity with mental health problems, emerging evidence suggests that positive emotions play an integral, but complex, role in the association of early-life adversity with psychopathology. This chapter identifies two pathways through which positive emotion influences risk for psychopathology following early-life adversity. First, experiences of early-life adversity may alter the development of the “positive valence system”, which in turn increases risk for psychopathology. Second, the association between adversity and psychopathology may vary as a function of individual differences in positive emotionality. We consider how the development of positive emotionality—measured at psychological, behavioral and neurobiological levels—may be altered by early-life adversity, creating a diathesis for psychopathology. We additionally review evidence for the role of positive emotion, measured at multiple levels, as a protective factor that buffers against the adverse impacts of adversity. In integrating these two roles, it is proposed that characteristics of environmental adversity, including developmental timing, duration, and type of adversity, may differentially impact the development of positive emotionality, leading to a better understanding of risks associated with specific adverse experiences. Methodological issues regarding the measurement of adverse environments as well as implications for early intervention and treatment are discussed.

Pursuing Positive Emotion

Experiencing positive emotion is often linked with greater psychological health and lower psychopathology. However, a growing body of research suggests a surprising paradoxical effect: in spite of the benefits of experiencing positive emotion, there may be important downsides to pursuing positive emotion. This chapter reviews current findings on the paradoxical effects of pursuing positive emotion (often focusing on the specific emotion of happiness), discusses possible mechanisms to explain these paradoxical effects, and suggests methods to avoid these effects. Specifically, the chapter outlines three key mechanisms for the paradoxical effects of pursuing happiness: First, as people pursue happiness, they tend to set high standards for their happiness which can result in disappointment. Second, when people are inaccurate about how to achieve happiness, they may engage in activities that are counterproductive for achieving happiness and psychological health. Third, as people pursue happiness, they may monitor their experience of happiness which can directly interfere with the experience of happiness. These processes, in turn, may create risk for psychopathology. Fortunately, these three mechanisms also suggest how to avoid paradoxical effects of pursuing happiness: by removing impossibly high standards, disappointment can be avoided; by engaging in productive happiness pursuits, people can attain more sustainable happiness; and by automatizing the process of pursuing happiness, the ill-effects of monitoring can be avoided. Although pursuing happiness can paradoxically lead to reduced happiness and greater psychopathology, by understanding the mechanisms underlying this paradox, we can obtain valuable insights into effective ways to achieve happiness and avoid psychopathology.

Positive Valence System Dysregulation in Psychosis

Motivational and hedonic impairments cut across diagnostic categories, are core aspects of psychopathology, and may be crucial for understanding pathways to development and maintenance of psychopathology. Given the pervasive nature of motivational and hedonic deficits across psychopathology forms, the Research Domain Criteria initiative includes a “positive valence” systems domain that outlines constructs critical for understanding motivational and hedonic impairments in psychopathology. These constructs include initial responsiveness to reward, reward anticipation or expectancy, incentive or reinforcement learning, effort valuation, and action selection. The chapter reviews behavioral and neuroimaging studies providing evidence for construct impairments in in individuals with psychosis versus individuals with depressive pathology. Evidence suggests there are meaningful differences in reward-related and hedonic deficits associated with psychosis versus depression. These differences have implications for understanding the differential etiology of these forms of psychopathology and the ways treatment development may need to proceed for each domain. The literature suggests that individuals with depressive pathology experience impairments of in-the-moment hedonics or “liking,” particularly among those who experience anhedonia. Given that hedonic experience is the basis in many ways for all other aspects of motivational function, such deficits may propagate forward and contribute to impairments in other constructs dependent on hedonic responses. In contrast, individuals with psychosis have relatively intact in-the-moment hedonic processing, instead experiencing impairments in process aspects that translate reward to action selection. More specifically, individuals with schizophrenia exhibit altered reward prediction and associated striatal and prefrontal activation, impaired reward learning, and impaired reward-modulated action selection.

Reward Hypersensitivity in Bipolar Spectrum Disorders

The behavioral approach system (BAS)/reward hypersensitivity model of bipolar disorder proposes that risk for bipolar disorder, in particular hypo/manic episodes, is characterized by a hypersensitivity to goal- and reward-relevant cues. This hypersensitivity can lead to an excessive increase in approach-related affect and motivation to positive or rewarding life events, which, in the extreme, is reflected in hypo/manic symptoms. By contrast, multiple other psychiatric disorders, including major depressive disorder, attention deficit hyperactivity disorder, schizophrenia, and anxiety, appear to be characterized by reduced or unaffected reward processing. This suggests that elevated reward processing may be unique to bipolar disorder and thus important for understanding the differential risk for bipolar symptoms and the pathophysiology of hypo/manic episodes. The objective of the present chapter is four-fold. First, the literature on reward processing and reward-related neural activation in bipolar disorder is reviewed, in particular risk for hypomania/mania. Second, it is proposed that reward-related neural activation reflects a unique biological marker of risk for bipolar disorder that may help facilitate psychiatric assessment and differential diagnosis. Third, the pharmacological and psychosocial treatment implications of research on reward-processing and reward-related neural activation in bipolar disorder are addressed. Finally, new and novel directions of research on reward processing in bipolar disorder are discussed, including an integrated reward and circadian rhythm dysregulation model of bipolar symptoms and our neuroimmune network hypothesis of abnormalities in reward processing across mood-related disorders.

Positive Emotional Disturbance in Psychopathology

Positive mood scales are negatively associated with many symptoms and disorders, but display positive relations with other forms of psychopathology. The basic goal of this chapter is to explicate the nature of these complex associations. The data we present clearly established that the size and sign of these relations depended on the specific mood measure that was used. More specifically, our results indicated that there were two basic types of positive mood scales. The first type of scale was best exemplified by PANAS-X Joviality and IDAS-II Well-Being. High scorers on these scales report feeling happy, cheerful, lively, enthusiastic, and optimistic. These scales tap a very adaptive form of positive affect, as they tended to correlate negatively with psychopathology. They displayed substantial specificity in their relations, however, correlating most strongly with indicators of depression and anhedonia, and also with social aloofness and other negative symptoms of psychoticism. The second type of scale was exemplified by IDAS-II Euphoria and, to a lesser extent, PANAS-X Self-Assurance. High scorers on these scales report feeling elated, energetic, restless, grandiose, bold, and extremely confident. These scales clearly assess a more dysfunctional form of positive affect, as they tended to correlate positively with psychopathology. Again, however, they displayed considerable specificity in their relations, correlating most strongly with indicators of elevated positive mood within mania, various forms of externalizing, and positive symptoms of psychoticism. These findings demonstrate the importance of examining multiple types of positive mood in psychopathology research.