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University of Groningen

Psychopathology and positive emotions in daily life

Heininga, Vera E.; Kuppens, Peter

Published in:

Current Opinion in Behavioral Sciences DOI:

10.1016/j.cobeha.2020.11.005

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Heininga, V. E., & Kuppens, P. (2021). Psychopathology and positive emotions in daily life. Current Opinion in Behavioral Sciences, 39, 10-18. https://doi.org/10.1016/j.cobeha.2020.11.005

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Psychopathology

and

positive

emotions

in

daily

life

Vera

E

Heininga

1

and

Peter

Kuppens

2

Inthisshortreview,wedescriberecenttrendsfromEcological MomentaryAssessment(EMA)researchinvestigatingpositive affect(PA)inrelationtomooddisorders.Asidefromnotable exceptions(e.g.mania),mostmooddisordersinvolverelatively lowerlevelsofPAindailylife,oftencombinedwithalargerlevel ofvariabilityinPA.Inreactiontopositiveevents,studiesshowa puzzling‘moodbrightening’effectinindividualswithmood disordersymptomsthatsuggestshyperresponsivenessto real-liferewards.Studiesintoanhedonia(i.e.lackof,orlower levelsofPA)suggestthathigh-arousalPAandanticipatoryPA arepotentialtargetsforintervention.DespitePA-focused EMA-interventionsbearpromisesofgreatertherapeutic

effectiveness,sofar,thesepromiseshavenotmaterializedyet.

Addresses

1UniversityofGroningen,FacultyofBehaviouralandSocialSciences,

DepartmentofDevelopmentalPsychology,GroteKruisstraat2/1, 9712TSGroningen,TheNetherlands

2LeuvenUniversity,FacultyofPsychologyandEducationalSciences,

QuantitativePsychologyandIndividualDifferences,Tiensestraat102, Box3713,3000Leuven,Belgium

Correspondingauthor:Heininga,VeraE(v.e.heininga@rug.nl)

CurrentOpinioninBehavioralSciences2020,39:10–18 ThisreviewcomesfromathemedissueonPositiveAffect

EditedbyGillesPourtois,DisaSauter,BlairSaundersandHenkvan Steenbergen

https://doi.org/10.1016/j.cobeha.2020.11.005

2352-1546/ã2020TheAuthor(s).PublishedbyElsevierLtd.Thisisan openaccessarticleundertheCCBYlicense(http://creativecommons. org/licenses/by/4.0/).

Introduction

Inmood disorders feelingsor emotions are distorted or

inconsistent with its context to such an extent that it

interferes with one’s ability to function [1]. Mood

dis-ordersincludeBipolarDisorder,Dysthymia,Cyclothymic

Disorder, Premenstrual Dysphoric Disorder, and Major

Depressive Disorder (MDD), and affect approximately

10% of the population each year [2,3]. Research on

affective psychopathology is predominantly focused on

stressand Negative Affect (NA). In recent years,

how-ever,therehasbeenincreasingattentionandrecognition

thatrewarding experiencesandPositive Affect(PA), or

thelackthereof(i.e.anhedonia),isatleastequally

impor-tant for the understanding, treatment of, and recovery

from,mooddisorders.

PA generally refers to the experience of pleasurable

emotions, such as happiness, relaxation, enthusiasm,

andjoy, andvaries over time asa function of

subjec-tivelyappraisedcontext[4,5].Whenitcomesto

under-standing the nature of PAin the context of people’s

daily life, Ecological Momentary Assessment (EMA)

studieshaveexaminedthelevelofPA,itsfluctuations,

and interaction with contexts in both healthy and

clinical populations. EMA is a structured diary

tech-niquetosamplesubjective experiences,behaviorand

contextintheflowofdailylife,typicallyusing

smart-phone technology. Its naturalistic approach ensures

ecologicallyvalid data (i.e. generalizable to real-life),

Participantstypically fill out structureddiaries

multi-pletimesaday(e.g.fivetimesaday),thatareassessed

at fixed or random time points, and across multiple

consecutives days (e.g. for 30 days). The high

fre-quency in longitudinal sampling enables researchers

toshed light on the nature of mood disorders on the

micro-level.Forexample,towhatextentdepressionis

linkedtoPAchangesacrossminutesorhours,andthe

extenttowhichtheseshort-termchangesinPAco-vary

withbehaviororothercontextualfactorsovertime.In

addition, compared to retrospective questionnaires

that asks patients to report on symptoms during the

pastweeks ormonths,the frequentsamplinginEMA

studiesreduces recallbias.Inthatsense, EMA

meth-ods can not only validate diagnostic criteria in daily

life,butalsogobeyondbyprovidingnovelinsightsinto

the micro-processes and mechanisms of mood

disorders.

Inwhatfollows,wereview someof themostimportant

advancementsofEMAresearchinPAand

psychopathol-ogyover thelastfiveyears.

Positive

Affect

(PA)

in

daily

life

In EMA studies, PA is typically operationalized as the

mean of a set of adjective rating scales. For example,

participantsareasked‘Howdoyoufeelatthemoment?’

followed by the adjectives ‘relaxed’, ‘happy’, and

‘cheerful’ and a slider-scale anchored with ‘not at all’

(outerleft)and‘verymuch’(outerright).Often,butnot

always,thesetofaffectiveitemsisbasedonthePositive

AffectandNegative AffectSchedule[6],or isbasedon

circumplexmodelsofaffect[7,8]withtheselectionmade

to balance high and low arousal items [9]. The most

frequently used adjectives used to describe PA in

EMAresearchinrelationtomooddisordersoverthelast

two years are feeling relaxed, happy, and cheerful (see

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EMA studies have linked compromised mental health

andmooddisorderstovariousalterationsinPA

function-ing,suchasreducedPAcomplexityandPAflexibilityin

daily life [10],blunted PA reactivityto daily life stress

([11]) and reduced expectations of future PA (Note:

when having a history of depression, but not bipolar

disorder; [12]). The most robust finding, however, is

theconsistentlinkbetweenlowerpsychological

wellbe-ing or increased mood disorder symptomatology and

lower mean levels of PA [10,12,13,14,15,16,17,18,20].

One exceptionshould be noted though,namely in the

manicphasesofbipolardisorder,whichmanifestsas(too)

high levelsofPA.

PA

dynamics

in

mood

disorders

Inadditiontotherobustlinkbetweenmooddisordersand

lower mean level is PA in daily life, EMA researchers

explored the link between mood disorders and the

dynamic nature of PA. PA dynamics are quantitative

descriptions of PA summarizing how PA unfolds and

fluctuatesovertime.Forexample,emotionalvariability,

operationalizedas theaveragewithin-personvariancein

affectoraveragewithin-personStandardDeviation(SD)

in affect, summarizes the dispersion in PA levels. In

addition,therearemorecomplexaffectivedynamicssuch

as inertia (i.e. auto-correlation or auto-regression

coeffi-cient;summarizeshowself-predictiveaffectisovertime),

PsychopathologyandPAindailylifeHeiningaandKuppens 11

Figure1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 3 3 4 4 4 4 4 6 7 7 8 9 11 0 2 4 6 8 10 12 alert amazed at ease confident content delighted enjoying myself even temper euphoric globally feeling well jittery safe surprised warm active attentive inspired strong excited lively calm determined interested joyful proud energetic enthusiastic satisfied cheerful happy relaxed

Current Opinion in Behavioral Sciences

TheEcologicalMomentaryAssessments(EMA)itemsusedtoassessPositiveAffect,extractedfrom17EMAstudiesthatreportedonPAand mooddisordersbetween2018andJune2020.NumberontheX-axisreflectsnumberofstudiesthatusedtheEMA-itemdipictedontheY-axis. WesearchedinWebofScience(WoS)CoreCollectionelectronicdatabaseforEnglish-languagepaperspublishedbetween2018andJune 2020usingthefollowingkeyterms:‘positiveemotion*’OR‘positiveaffect*’OR‘positivemood*’ORpleasur*ORwell?beingOReudaimon*;and ‘Mooddisorder*’OR‘Affect*disorder*’OR‘Bipolar*’OR‘BipolarDisorder*’ORDepress*OR‘MajorDepressiveDisorder’ORMDDORanhedoni*; and‘Experiencesampling’OR‘EcologicalMomentaryAssessment*’OR‘ExperienceSamplingMethod’OR‘structureddiarymethod*’OR ‘intensivelongitudinalassessment*’OR‘real-timedatacapturestud*’OR‘eventsampl*’OR‘beeperstud*’OR‘ambulatorystud*’intitle,abstract, authorkeywords,andKeywordsPlus.Fromthe90articles,24weremarkedasrelevantbecausethey(1)explicitlyorimplicitlyhandledthesubject ofpositiveaffectoranhedonia;(2)hadafocusonmentalhealthormooddisorder,and(3)usedEMA.Weexcludedstudiesthatfocusedon(1) genetics,orneurologicalunderpinnings;(2)methodologicalstudies;and(3)studiesthatdidnotreportonPAitems,leaving17recentEMAstudies forextractionofPAitems.

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summarizeshowunstableaffectisovertime).Foravisual

illustrationof thesedynamics,seeFigure2.

Recent EMA studies report paradoxical results in this

respect. Whereas some studies found no association

between PA dynamics and mood disorders [14,17],

others have linked symptoms of mood disorders and

low psychological well-being to greater variability in

PA ([15]in high-arousal PA; first studyof [16,19,21]),

and/ormoreinertPA[16,22,23].Inthemeta-analyseson

therelation betweenaffectdynamicsand psychological

well-being, lowerwell-being was characterized byboth

greater variability and inertiairrespective of ESM time

frame [16]. However, this inertia-variability paradox is

resolved when taking the overlap among the mean,

variability, and inertia into account (i.e. by controlling

foroneortheother).Indeed,althoughPAdynamicsare

interrelated,thedifferencesbetweengroupsinthelevel

ofvariability(e.g. variance)andthelevelofinertia(e.g.

autocorrelation)inPAaretypicallyexaminedinisolation.

EMAresearchonnegativeaffectandwellbeingsuggests

that, when adjusted for the overlap, inertia adds little

predictivevalueinthepredictionofmooddisordersover

andabovethelowerlevelofPAandlargerspreadinPA

levels([24,25,26];seealsoFigure 2).

In people with bipolar disorder, after controlling for

differences in individuals’ mean PA, variability in PA

stillprovidesuniqueandadditionalinformation[19,21].

However, over-and-abovethe PA mean and variability,

the auto-correlation of PA (inertia) likely adds limited

informationinpredictingpsychologicalhealth[25].

Real-life

reward

responsiveness

and

mood

brightening

The EmotionContext Insensitivitytheory andpositive

attenuation hypothesis predict attenuated emotional

reactivitytopositiveemotionalstimuliinthedailylives

ofdepressedindividuals[27].Inlinewiththishypothesis

and theory, depression is consistently associated with

reduced reward responsiveness in experimental studies

andneurologicalstudiesinthelaboratory[28–31].Instark

contrast,resultsfromEMAstudiesshoweitherno

differ-encesindepressedindividuals’rewardresponsiveness,or

evidence for theopposite: a ‘mood brightening effect’,

defined as a greater improvement in the mood of

depressed individuals in the hours after they report

havingexperiencedapositiveevent.3

alarger decreasein NA and larger increase in PA after

positiveeventsin depressedversusnon-depressed

indi-viduals[32].MostEMAstudiesthereafterpredominantly

focused on the brightening in NA (e.g. Ref. [33]).

Althoughinstarkcontrasttotheoryandempiricalresults

fromthelaboratory, themoodbrightening effectin PA

seemsrobustand,comparedtoanxiety,specificto

depres-sion—withmoreseverelydepressedindividualsshowing

greaterbrightening[34].Interestingly,anticipating

next-daypositiveeventsseemtoproducesimilarmood

bright-eningeffects [35].

Sofar,severalfactorshavebeenexcludedasthedriving

forcebehindthemoodbrighteningeffect[36].First,the

scarcity in positive events that is often observed in

depressed patients (i.e. contrast hypothesis). Second,

thelowerthresholdtoappraisepositiveeventsaspositive

and,third, flooreffects in PAthatmaycreate relatively

larger room for improvement in the PA of depressed

individuals Perhaps, emotion regulation might (partly)

explain mood brightening effects. For NA, depressed

individuals’tendencytoruminate(i.e.focusedattention

tonegativeeventsandmoods)mightbeloweredbythe

experience of a positive event to an extent that they

ruminate less than controls, and the subsequent lower

levelof NApresentsitselfasamoodbrighteningeffect

[33].

Anotherexplanationforthediscrepancybetweentheory

andEMAresultsonrewardresponsivenesscouldbethat

PAreactivitytotheself-reportedpleasantnessofanevent

is a suboptimal operationalization. Bakker et al. [37]

arguedthatexperimentaltasksandbehavioralactivation

therapy typically involve approach-based rewards,

sug-gestingthat situationsin whichone canencounter

rela-tivelymanyrewards(e.g.engagingwithfriends,working

orbeingphysicallyactive;hereafter‘activebehavior’)isa

betteroperationalizationortranslationofrewardsindaily

life than (pleasantness ratings of) positive events.

Remarkably, when operationalizing reward

responsive-nessindailylifeasPAreactivitytoactivebehavior,inline

withtheory,theauthorsindeedobserveabluntedreward

responsivenessinindividualswithdepressivesymptoms.

However, the new operationalization is still awaiting

replication.Heininga et al. [14] exploredboth

operatio-nalizationsofrewardresponsivenessinthedailylivesof

depressed patients and healthy controls, but found no

differencebetweenbothgroupsinPAreactivityto

posi-tiveevents,norinPAreactivity toactive behavior.

Anhedonia

in

daily

life

TobetterunderstandPAinmooddisorders,itmayalsobe

useful to shift the focus from syndromes to symptoms

[38]. Anhedonia is one of the two core symptoms of

depression and is clinically understood as ‘a markedly

diminished interest or pleasure in all, or almost all,

3

ItshouldbenotedthatonerecentEMAstudyreportedreduced reward responsiveness in depressedindividuals, but, instead of the changeinPAafterpleasantactivitiesorevents,rewardresponsiveness wasoperationalizedasthepleasantnessratingofdailyactivities[61], betterknownasappraisal.

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activitiesoftheday’duringthepasttwoweeks[1].Based

onadvances inneurologyandexperimentalpsychology,

anhedonia is now understood as impairments in the

ability toexperience reward(i.e.deficit in‘liking’;

con-summatory anhedonia), pursue reward (i.e. deficit in

‘wanting’; anticipatory anhedonia) and/or learn about

reward ([39–42];butseeRef.:[43]).

Withregardto‘liking’indailylife,anhedoniaislinkedto

lowerappraisalofpositiveevents(i.e.positiveeventsare

rated less pleasurable; [15]; but see Ref.: [20]), fewer

positiveeventexperiences[20],andlowerlevelsofPAin

daily life[14,15,20,44]. Beyondthese descriptive

statis-tics, anhedonic versus non-anhedonic individuals also

show differences in their associations between events

and PAover time.Consummatoryhigh-arousal PA(e.g.

feeling ‘energetic’, ‘enthusiastic’, and ‘cheerful’) might

beofspecialinteresttobetterunderstandanhedonia,as

individuals with anhedoniashow ‘mood brightening’in

high-arousalPAbutnotlow-arousalPA[15],andshowa

diminished favorableimpactonaffectiveexperiencesin

individuals with anhedonia [44]. That is, compared to

healthy controls, high-arousal PA in individuals with

anhedonia istypically followed byagreater increase in

NAandstress,andagreaterdecreaseinPAandphysical

activityapproximatelysixhourslater (seeFigure 3).

With regard to ‘wanting’, EMA studies suggest that

alterations in motivationand anticipation mightalso be

avulnerabilitymarkerformooddisorders.Forexample,

low PA in anhedoniais associated with lower levelsof

motivationsixhourslater[45],andtheresultssuggestthat

individualswithanhedoniaareatriskforanegativespiral

of low PAandlow motivation.Furthermore,depressive

symptoms are also linked to diminished anticipatory

pleasure experiences[46], and a weaker link between

anticipatorypleasureandactivebehavior[37].Together,

theseEMAadvancessuggestthat,inadditiontoalower

meanlevelofPA,individualswithdepressivesymptoms

are less able or less motivated to modify their daily

behaviorsasafunctionof rewardanticipation.

Withregardtodeficitsinrewardlearninginthedailylives

of individuals with anhedonia, advances show that the

EMA timeframe is key. Without conscious processing,

individualslearnabouttherewardvalueofeachcontext

and activity by creating associations with co-occurring

rewarding experiencessuch asPA. Theseimplicit

asso-ciations,in turn,increasethelikelihoodthatindividuals

engage insimilar contexts and activitiessemi-randomly

assessed approximately 90min later and the next day

[47].However,suchassociativelearningeffectswerenot

replicated when using a short-term retrospective ESM

design with fixed beeps approximately six hours apart

[48].MoreEMAresearchisthusneededtodeterminethe

optimaldesigntoinvestigaterewardlearningindailylife.

PA-focused

daily

life

interventions

Giventhattheone-size-fits-alltreatmentapproachisnot

alwayseffective, EMAInterventions(EMIs) havebeen

put forward as a promisingtool to personalize affective

disordertreatmentsandimprovetheireffectiveness(e.g.

Refs.[49–52]).Sofar,threeEMIshavebeendeveloped

thatfocusonPAand (symptomsof) mooddisorders.

PsychopathologyandPAindailylifeHeiningaandKuppens 13

Figure2

Current Opinion in Behavioral Sciences

HypotheticalexampleofhowPAunfoldsovertimeinindividualswithmooddisorderversushealthycontrols.Basedonindividualpatientdata fromHeiningaetal.[14].

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InthefirstRandomizedControlledTrials(RCT)ESM-I

study,depressivesymptomswereeffectivelyreducedby

sixweeklysessionsofESM-basedPA-feedback[53].The

feedback purely descriptive, for example, graphically

showingpatients’ownlevelofPAacrossdifferent

situa-tions. A follow-up study revealed that the decrease in

depressive symptoms was preceded by a decrease in

sedentary behaviorsandan increasein physicalactivity

and social behaviors [54], suggesting that lifestyle

changesmaybepart oftheremedy.Itshould benoted

though that, although patients’ depressive complaints

reduced according to the Hamilton Depression Rating

ScaleandtheInventoryofDepressiveSymptoms,

accord-ingtotheEMAassessments,patients’momentarylevels

ofPAdidnotchangeduringtheintervention[55].

Next, beyond mere descriptive feedback, van Roekel

etal. [20,56,57]showed thatevaluative feedbackin the

formofESM-basedrecommendationsonhowtochange

one’slifestylemight beamore effectivewayto reduce

depressivesymptoms–atleastinasubclinicalsample.

Albeiteffectsizesweresmall,andparticipantsshowedno

marked decrease in depressive symptoms according to

the Patient Health Questionnaire, self-monitoring in

No anhedonia Anhedonia

Current Opinion in Behavioral Sciences

AdaptedfromFigure2ofBosetal.[44].Networksofanhedonicandnon-anhedonicindividualsshowingthestrengthoftheIRFassociations estimatedthroughautomatedimpulseresponsefunctionanalysis(IRF).Green(solid)arrowsindicatepositiveassociationsbetweenvariables;red (dashed)arrowsnegativeones.Thestrongeraparticularassociation,thethickerandbrighterthecolorofthearrow.

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combinationwithspecific recommendationsforlifestyle

changes effectively increased participants’ PA levels

throughout daily life, suggesting evaluative feedback

may also be an effective way to augment the efficacy

of regulardepressiontreatment.Inlinewiththese

find-ings, indeed, recent advances on Behavioral Activation

treatments suggest that these treatments may work by

targeting(low)reward responsivenessdirectly[42,58].

Finally,Bastiaansenetal.[59,60]translatedthese

find-ingstoclinicalpracticebyprovidingbothdescriptiveand

evaluative Behavioral Activation based feedback on

patients’ PA, but found noevidence for improvements

compared to patients’ PA who followed treatment as

usual, nor evidence for an increase in EMI-specific

empowerment or social functioning of patients. When

comparingthestudyofBastiaansenetal.to thestudyof

PsychopathologyandPAindailylifeHeiningaandKuppens 15

Figure4

Time in months

Time in months

Current Opinion in Behavioral Sciences

Upperpart:adaptedFigure3bfromKrameretal.[53].Lowerpart:adaptedFigure2fromAppendixDfromBastiaansenetal.[60].Plotsshow predictedlinesplottedacrosstime(intention-to-treatanalysis).IDS=InventoryofDepressiveSymptomatology.Post-EMA=assessmentinthe weekafterthe28-dayinterventionperiod.FU=FollowUpassessment.InthestudyofBastiaansenetal.[60],duringthe28-dayintervention period,patientsreceivedweeklyfeedbackoneitherpositiveaffectandactivities(Do-module;experimental1)ornegativeaffectandthinking patterns(Think-module;experimental2).

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control groups of both studies (i.e. treatment as usual).

Whereas in Kramer’s study the treatment as usual was

medication which only marginally improved patients

moods, in the study of Bastiaansen et al., treatment as

usualconsistedofmedicationcombinedwith

psychother-apy which was more effective in improving patients’

moods in the control group. Although the PA-focused

EMIdidnot gobeyond theefficacy of medicationand

psychotherapy,Bastiaansenetal.,concludethatitmaybe

worthwhiletoinvestigatewhetherEMIscanbeblended

with routine mental health services as they have the

potential to make psychotherapy treatments more

time-efficientfor therapistswithoutsacrificingefficacy.

Conclusions

Recentadvances in the fieldof PositiveAffective (PA)

andmooddisordersindailylifesuggestthatpeoplewith

mood disorders typically experience relatively lower

levels of PA in daily life, possibly combined with a

reduced anticipatory PA, and moment-to-moment

vari-abilityinPAinbipolardisorder.FutureEMAstudiesinto

mood disorders may benefit from incorporating both

consummatoryPA (as experienced in-the-moment) and

anticipatory PA (looking forward to future activities or

contexts). Social contexts, stress and motivation seem

closelyrelatedtoPAinthedailylivesofindividualswith

anhedonia, and unravelling its underlying mechanisms

maybeanimportantnextstepinfine-tuningtreatments

formooddisorder.

Evidencefrom laboratory settings versusEMA appears

paradoxical, as laboratory studies show blunted reward

responses in depression, whereas EMA studies show

evidencefor theopposite(i.e. a‘PAbrighteningeffect’

inresponsetopositiveevents).Toreconcilebothstrands

ofliterature,futurestudiesmaybenefitfromamore

in-depthanalysisintothetypeofpositiveevents,aswellas

theoperationalizationsofrewardresponsivenessindaily

life.Forexample,byexploring possiblerelevant

differ-encesin thetypesof positiveevents(e.g. intrapersonal/

interpersonalevents,orsocial/non-socialevents),andPA

reactivity to positive events active behavior, while also

includingreward-related laboratory test batteriesin the

sameEMAstudyparticipants.Thatway,reward

respon-sivenessindailylifecouldbe‘calibrated’bycomparing

correlational patterns. Another promising direction for

futureresearch wouldbe to investigatethe moderating

effectsofPAregulationstrategiesonPAbrighteningafter

positiveeventsand/oractive behavior.

AlthoughthepromisedtherapeuticefficacyofEMIshas

notfullymaterialized(yet),PA-focusedEMIsthataimto

alterbehaviorindailylifeseemacost-effectiveandeasily

accessible alternative for patients who cannot receive

standardBehavioral Activationtherapy,or notyet.

Fur-thermore,EMIsmayhelptounderstandthemechanisms

treatment.ThereareindicationsthatfuturePA-focused

EMIs may bemost effective whentargeting both

con-summatoryandanticipatoryPAaswellasthestrengthof

the connection between both, and involve a type of

evaluativefeedbackwhich ispreferablyintegratedwith

face-to-facetherapistguidancesessions.

Conflict

of

interest

statement

Nothingdeclared.

CRediT

authorship

contribution

statement

VeraEHeininga:Conceptualization,Investigation,

Visu-alization,Datacuration,Writing-originaldraft,Writing

-review & editing. Peter Kuppens: Conceptualization,

Writing-review& editing.

Acknowledgement

ThisworkwassupportedbytheC1grantbytheKULeuvenResearch Council(C14/19/054).

References

and

recommended

reading

Papersofparticularinterest,publishedwithintheperiodofreview, havebeenhighlightedas

 ofspecialinterest ofoutstandinginterest

1. AmericanPsychiatricAssociation:DiagnosticandStatistical ManualofMentalDisorders.edn5.2013http://dx.doi.org/ 10.1176/appi.books.9780890425596.

2. KesslerRC,BerglundP,ChiuWT,DemlerO,HeeringaS,HiripiE, JinR,PennellB-E,WaltersEE,ZaslavskyA,ZhengH:TheUS NationalComorbiditySurveyReplication(NCS-R):designand fieldprocedures.IntJMethodsPsychiatricRes2004,13:69-92 http://dx.doi.org/10.1002/mpr.167.

3. NationalInstituteofMentalHealth(NIMH):Anymooddisorder [StatisticsonMentalHealthInformation].AnyMoodDisord 2020https://www.nimh.nih.gov/health/statistics/

any-mood-disorder.shtml#part_155955.

4. CarverCS:ControlProcesses,PriorityManagement,andAffective Dynamics:EmotionReview.2015http://dx.doi.org/10.1177/ 1754073915590616.

5. FrijdaNH,MesquitaB:Thesocialrolesandfunctionsof emotions.EmotionandCulture:EmpiricalStudiesofMutual Influence.AmericanPsychologicalAssociation;1994:51-87http:// dx.doi.org/10.1037/10152-002.

6. WatsonD,ClarkLA,TellegenA:Developmentandvalidationof briefmeasuresofpositiveandnegativeaffect:thePANAS scales.JPersSocPsychol1988,54:1063-1070http://dx.doi.org/ 10.1037/0022-3514.54.6.1063.

7. FeldmanBarrettL,RussellJA:Independenceandbipolarityin thestructureofcurrentaffect.JPersSocPsychol1998,74 :967-984http://dx.doi.org/10.1037/0022-3514.74.4.967.

8. YikMSM,RussellJA,BarrettLF:Structureofself-reported currentaffect:integrationandbeyond.JPersSocPsychol 1999,77:600.

9. RussellJA:Acircumplexmodelofaffect.JPersSocPsychol 1980,39:1161-1178http://dx.doi.org/10.1037/h0077714. 10. DejonckheereE,MestdaghM,HoubenM,ErbasY,PeM,KovalP,

BroseA,BastianB,KuppensP:Thebipolarityofaffectand depressivesymptoms.JPersSocPsychol2018,114:323-341 http://dx.doi.org/10.1037/pspp0000186AMER

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11. BooijSH,SnippeE,JeronimusBF,WichersM,WigmanJTW: Affectivereactivitytodailylifestress:relationshiptopositive psychoticanddepressivesymptomsinageneralpopulation sample.JAffectDisord2018,225:474-481http://dx.doi.org/ 10.1016/j.jad.2017.08.051BosELSEVIERSCIENCEBV. 12. ThompsonRJ,SpectreAS,InselP,MenninD,GotlibIH,GruberJ:

Positiveandnegativeaffectiveforecastinginremitted individualswithbipolarIdisorder,andmajordepressive disorder,andhealthycontrols.CognitTherRes2017,41 :673-685http://dx.doi.org/10.1007/s10608-017-9840-2.

13. BakkerJM,GoossensL,KumarP,LangeIMJ,MichielseS, SchruersK,BastiaansenJA,LieverseR,MarcelisM,van AmelsvoortTetal.:Fromlaboratorytolife:associatingbrain rewardprocessingwithreal-lifemotivatedbehaviourand symptomsofdepressioninnon-help-seekingyoungadults. PsycholMed2019,49:2441-2451http://dx.doi.org/10.1017/ S0033291718003446CAMBRIDGEUNIVPRESS.

14. HeiningaVE,DejonckheereE,HoubenM,ObbelsJ,SienaertP, LeroyB,vanRoyJ,KuppensP:Thedynamicalsignatureof anhedoniainmajordepressivedisorder:positiveemotion dynamics,reactivity,andrecovery.BMCPsychiatry2019,19

http://dx.doi.org/10.1186/s12888-018-1983-5BMC.

15. HeiningaVE,vanRoekelE,AhlesJJ,OldehinkelAJ,MezulisAH: Positiveaffectivefunctioninginanhedonicindividuals’daily lifeanythingbutflatandblunted.JAffectDisord2017,218 :437-445http://dx.doi.org/10.1016/j.jad.2017.04.029.

16. HoubenM,VanDenNoortgateW,KuppensP:Therelation betweenshort-termemotiondynamicsandpsychological well-being:ameta-analysis.PsycholBull2015,141:901-930 http://dx.doi.org/10.1037/a0038822.

17.

 NelsonemotionalJ,KlumparendtdynamicsinA,majorDoeblerdepression.P,EhringEmotionT:Everyday2020, 20:179-191http://dx.doi.org/10.1037/emo0000541AMER

PSYCHOLOGICALASSOC.

InvestigatestheeverydayPA dynamicsofdepressedindividuals(e.g. inertia,contextinsensitivity,andvariability),andshowsnodifferencesin thedynamicsofPAbetweendepressedandhealthysubjects. 18. SperrySH,Barrantes-VidalN,KwapilTR:Theassociationof

affectivetemperamentsandbipolarspectrum

psychopathology:anexperiencesamplingstudy.MotivEmot 2018,42:126-136http://dx.doi.org/10.1007/s11031-017-9652-4

SPRINGER/PLENUMPUBLISHERS.

19. SperrySH,KwapilTR:Affectivedynamicsinbipolarspectrum psychopathology:modelinginertia,reactivity,variability,and instabilityindailylife.JAffectDisord2019,251:195-204http:// dx.doi.org/10.1016/j.jad.2019.01.053ELSEVIERSCIENCEBV. 20. vanRoekelE,BennikEC,BastiaansenJA,VerhagenM,OrmelJ,

EngelsRCME,OldehinkelAJ:Depressivesymptomsandthe experienceofpleasureindailylife:anexplorationof associationsinearlyandlateadolescence.JAbnormChild Psychol2016,44:999-1009 http://dx.doi.org/10.1007/s10802-015-0090-z.

21.

 SperryconcurrentlySH,WalshandMA,prospectivelyKwapilTR:predictEmotionmooddynamics

psychopathology.JAffectDisord2020,261:67-75http://dx.doi. org/10.1016/j.jad.2019.09.076ELSEVIER.

Shows that, aftercontrolling for differences inindividuals’ meanPA, variabilityinPAstillprovidesuniqueandadditionalinformationinpeople withbipolardisorder.

22. KiekensG,HaskingP,NockMK,BoyesM,KirtleyO,BruffaertsR, Myin-GermeysI,ClaesL:Fluctuationsinaffectivestatesand self-efficacytoresistnon-suicidalself-injuryasreal-time predictorsofnon-suicidalself-injuriousthoughtsand behaviors.FrontPsychiatry2020,11http://dx.doi.org/10.3389/ fpsyt.2020.00214FRONTIERSMEDIASA.

23. KovalP,Su¨tterlinS,KuppensP:Emotionalinertiaisassociated withlowerwell-beingwhencontrollingfordifferencesin emotionalcontext.FrontPsychol2015,6:1997http://dx.doi.org/ 10.3389/fpsyg.2015.01997.

24. BosEH,deJongeP,CoxRFA:Affectivevariabilityin depression:revisitingtheinertia-instabilityparadox.BrJ

Psychol(London,England:1953)2019,110:814-827http://dx.doi. org/10.1111/bjop.12372.

25.

 DejonckheereKuppensP,TuerlinckxE,MestdaghF:ComplexM,HoubenaffectM,dynamicsRuttenI,SelsaddL,limited informationtothepredictionofpsychologicalwell-being.Nat HumBehav2019,3:478-491 http://dx.doi.org/10.1038/s41562-019-0555-0.

FollowingKovaletal.[13](Emotion,13,1132)andBosetal.[24](British Journal ofPsychology, 110, 814–827)who didsimilar analyses with regardtoNA,thisstudyshowsthatmooddisordersmaynotbelinked togreatervariabilityinPAperse,asitoftendisappearsaftercontrolling fordifferencesinmeanPA.

26. KovalP,PeML,MeersK,KuppensP:Affectdynamicsinrelation todepressivesymptoms:variable,unstableorinert? Emotion (Washington,D.C.)2013,13:1132-1141http://dx.doi.org/10.1037/ a0033579.

27. RottenbergJ,GrossJJ,GotlibIH:Emotioncontextinsensitivity inmajordepressivedisorder.JAbnormPsychol2005,114 :627-639http://dx.doi.org/10.1037/0021-843X.114.4.627.

28. BylsmaLM,MorrisBH,RottenbergJ:Ameta-analysisof emotionalreactivityinmajordepressivedisorder.ClinPsychol Rev2008,28:676-691http://dx.doi.org/10.1016/j.

cpr.2007.10.001.

29. ForbesEE,DahlRE:Researchreview:alteredrewardfunction inadolescentdepression:what,whenandhow?:reward functionandadolescentdepression.JChildPsychol Psychiatry2012,53:3-15 http://dx.doi.org/10.1111/j.1469-7610.2011.02477.x.

30. KerenH,O’CallaghanG,Vidal-RibasP,BuzzellGA,BrotmanMA, LeibenluftE,PanPM,MeffertL,KaiserA,WolkeSetal.:Reward processingindepression:aconceptualandmeta-analytic reviewacrossfMRIandEEGstudies.AmJPsychiatry2018, 175:1111-1120http://dx.doi.org/10.1176/appi.

ajp.2018.17101124.

31. RottenbergJ,HindashAC:Emergingevidenceforemotion contextinsensitivityindepression.CurrOpinPsychol2015,4 :1-5http://dx.doi.org/10.1016/j.copsyc.2014.12.025.

32. PeetersF,NicolsonNA,BerkhofJ,DelespaulP,deVriesM: Effectsofdailyeventsonmoodstatesinmajordepressive disorder.JAbnormPsychol2003,112:203-211http://dx.doi.org/ 10.1037/0021-843X.112.2.203.

33. PanaiteV,KovalP,DejonckheereE,KuppensP:Emotion regulationandmoodbrighteningindailylifevarywith depressivesymptomlevels.CognitEmot2019,33:1291-1301 http://dx.doi.org/10.1080/02699931.2018.1543180.

34.

 Khazanoveffect:reactionsGK,RusciotopositiveAM,SwendseneventsinJ:theThedaily“Brightening”livesof individualswithmajordepressivedisorderandgeneralized anxietydisorder.BehavTher2019,50:270-284http://dx.doi.org/ 10.1016/j.beth.2018.05.008ELSEVIERINC.

An in-depth studyofthepuzzling ‘Brightening’effect, aswell asan analysisoftheextentofspill-overtootherdomainsofpsychological functioning.

35. StarrLR,HershenbergR:Depressivesymptomsandthe anticipationandexperienceofupliftingeventsineverydaylife. JClinPsychol2017,73:1442-1461http://dx.doi.org/10.1002/ jclp.22447.

36. BylsmaLM,Taylor-CliftA,RottenbergJ:Emotionalreactivityto dailyeventsinmajorandminordepression.JAbnormPsychol 2011,120:155-167http://dx.doi.org/10.1037/a0021662. 37. BakkerJM,GoossensL,LangeI,MichielseS,SchruersK,

LieverseR,MarcelisM,vanAmelsvoortT,vanOsJ, Myin-GermeysI,WichersM:Real-lifevalidationofreducedreward processinginemergingadultswithdepressivesymptoms.J AbnormPsychol2017,126:713-725http://dx.doi.org/10.1037/ abn0000294.

38. FriedEI,NesseRM:Depressionisnotaconsistentsyndrome: aninvestigationofuniquesymptompatternsintheSTARD study.JAffectDisord2015,172:96-102http://dx.doi.org/ 10.1016/j.jad.2014.10.010.

(10)

2009,9:65-73http://dx.doi.org/10.1016/j.coph.2008.12.014. 40. RømerThomsenK,WhybrowPC,KringelbachML:

Reconceptualizinganhedonia:novelperspectiveson balancingthepleasurenetworksinthehumanbrain.Front BehavNeurosci2015,9http://dx.doi.org/10.3389/

fnbeh.2015.00049.

41. TreadwayMT,ZaldDH:Reconsideringanhedoniain

depression:lessonsfromtranslationalneuroscience.Neurosci BiobehavRev2011,35:537-555http://dx.doi.org/10.1016/j. neubiorev.2010.06.006.

42. PizzagalliDA:Depression,stress,andanhedonia:towarda synthesisandintegratedmodel.AnnuRevClinPsychol2014, 10:393-423 http://dx.doi.org/10.1146/annurev-clinpsy-050212-185606.

43. DeFruytJ,SabbeB,DemyttenaereK:Anhedoniaindepressive disorder:anarrativereview.Psychopathology2020:1-8http:// dx.doi.org/10.1159/000508773.

44. BosFM,BlaauwFJ,SnippeE,vanderKriekeL,deJongeP, WichersM:Exploringtheemotionaldynamicsofsubclinically depressedindividualswithandwithoutanhedonia:an experiencesamplingstudy.JAffectDisord2018,228:186-193 http://dx.doi.org/10.1016/j.jad.2017.12.017.

45. vanRoekelE,HeiningaVE,VrijenC,SnippeE,OldehinkelAJ: Reciprocalassociationsbetweenpositiveemotionsand motivationindailylife:networkanalysesinanhedonic individualsandhealthycontrols.Emotion2019,19:292-300 http://dx.doi.org/10.1037/emo0000424.

46.

 DiminishedLiX,ZhangY,anticipatoryHuangZ-J,andChenconsummatoryX-L,YuanF-H,pleasureSunX-J:in dysphoria:evidencefromanexperiencesamplingstudy.Front Psychol2019,10http://dx.doi.org/10.3389/fpsyg.2019.02124

FRONTIERSMEDIASA.

Oneofthefirststudiestoinvestigatebothconsummatoryand anticipa-toryPAindailylifeinindividualswithdepressivesymptoms.

47. WichersM,KasanovaZ,BakkerJM,ThieryE,DeromC,JacobsN, vanOsJ:Fromaffectiveexperiencetomotivatedaction: trackingreward-seekingandpunishment-avoidantbehaviour inreal-life.PLoSOne2015,10:e0129722http://dx.doi.org/ 10.1371/journal.pone.0129722.

48. HeiningaVE,vanRoekelE,WichersM,OldehinkelAJ:Reward andpunishmentlearningindailylife:areplicationstudy.PLoS One2017,12:e0180753http://dx.doi.org/10.1371/journal. pone.0180753.

49. ColomboD,Ferna´ndez-A´lvarezJ,Patane´ A,SemonellaM, KwiatkowskaM,Garcı´a-Palacios A,CipressoP,RivaG,BotellaC: Currentstateandfuturedirectionsoftechnology-based ecologicalmomentaryassessmentandinterventionformajor depressivedisorder:asystematicreview.JClinMed2019, 8:465http://dx.doi.org/10.3390/jcm8040465.

50. DubadM,WinsperC,MeyerC,LivanouM,MarwahaS:A systematicreviewofthepsychometricproperties,usability andclinicalimpactsofmobilemood-monitoringapplications inyoungpeople.PsycholMed2018,48:208-228http://dx.doi. org/10.1017/S0033291717001659.

51. LinardonJ,CuijpersP,CarlbringP,MesserM, Fuller-TyszkiewiczM:Theefficacyofapp-supportedsmartphone interventionsformentalhealthproblems:ameta-analysisof

52. Myin-GermeysI,KasanovaZ,VaessenT,VachonH,KirtleyO, ViechtbauerW,ReininghausU:Experiencesampling methodologyinmentalhealthresearch:newinsightsand technicaldevelopments.WorldPsychiatry2018,17:123-132 http://dx.doi.org/10.1002/wps.20513.

53. KramerI,SimonsCJP,HartmannJA,Menne-LothmannC, ViechtbauerW,PeetersF,SchruersK,vanBemmelAL, Myin-GermeysI,DelespaulPetal.:Atherapeuticapplicationofthe experiencesamplingmethodinthetreatmentofdepression:a randomizedcontrolledtrial.WorldPsychiatry2014,13:68-77 http://dx.doi.org/10.1002/wps.20090.

54. SnippeE,JeronimusBF,aanhetRotM,BosEH,deJongeP, WichersM:Thereciprocityofprosocialbehaviorandpositive affectindailylife.JPers2018,86:139-146http://dx.doi.org/ 10.1111/jopy.12299WILEY.

55. HartmannJA,WichersM,Menne-LothmannC,KramerI, ViechtbauerW,PeetersF,SchruersKRJ,vanBemmelAL, Myin-GermeysI,DelespaulPetal.:Experiencesampling-based personalizedfeedbackandpositiveaffect:arandomized controlledtrialindepressedpatients.PLoSOne2015,10: e0128095http://dx.doi.org/10.1371/journal.pone.0128095. 56. VanRoekelE,VrijenC,HeiningaVE,MasselinkM,BosEH,

OldehinkelAJ:Anexploratoryrandomizedcontrolledtrialof personalizedlifestyleadviceandtandemskydivesasameans toreduceanhedonia.BehavTher2017,48:76-96http://dx.doi. org/10.1016/j.beth.2016.09.009.

57. vanRoekelE,MasselinkM,VrijenC,HeiningaVE,BakT, NederhofE,OldehinkelAJ:Studyprotocolforarandomized controlledtrialtoexploretheeffectsofpersonalizedlifestyle advicesandtandemskydivesonpleasureinanhedonicyoung adults.BMCPsychiatry2016,16:182http://dx.doi.org/10.1186/ s12888-016-0880-z.

58. ForbesCN:Newdirectionsinbehavioralactivation:using findingsfrombasicscienceandtranslationalneuroscienceto informtheexplorationofpotentialmechanismsofchange. ClinPsycholRev2020,79:101860http://dx.doi.org/10.1016/j. cpr.2020.101860.

59. BastiaansenJA,MeursM,StelwagenR,WunderinkL, SchoeversRA,WichersM,OldehinkelAJ:Self-monitoringand personalizedfeedbackbasedontheexperiencingsampling methodasatooltoboostdepressiontreatment:aprotocolof apragmaticrandomizedcontrolledtrial(ZELF-i).BMC Psychiatry2018,18http://dx.doi.org/10.1186/s12888-018-1847-z

BMC. 60.

 BastiaansenoftheefficacyJA,ofOrne´etwoDA,add-onMeursecologicalM,OldehinkelmomentaryA:Anevaluation interventionmodulesfordepressioninapragmatic randomizedcontrolledtrial(ZELF-i)[Preprint].PsyArXiv2020

http://dx.doi.org/10.31234/osf.io/8jfgc.

RandomizedControlledTrialofanEMIthattargetsbothofdepression’s coresymptoms:depressed moodand anhedonia,andexaminesthe effectsofEMA-monitoringand personalizedfeedbackondepressive complaintsinclinicalpracticebeyondtreatmentasusual.

61. WuH,MataJ,FurmanDJ,WhitmerAJ,GotlibIH,ThompsonRJ: Anticipatoryandconsummatorypleasureanddispleasurein majordepressivedisorder:anexperiencesamplingstudy.J AbnormPsychol2017,126:149-159http://dx.doi.org/10.1037/ abn0000244.

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