Assessment of Emotional Experience and Emotional Recognition in Complicated Grief

Abstract

There is substantial evidence of bias in the processing of emotion in people with complicated grief (CG). Previous studies have tended to assess the expression of emotion in CG, but other aspects of emotion (mainly emotion recognition, and the subjective aspects of emotion) have not been addressed, despite their importance for practicing clinicians. A quasi-experimental design with two matched groups (Complicated Grief, N = 24 and Non-Complicated Grief, N = 20) was carried out. The Facial Expression of Emotion Test (emotion recognition), a set of pictures from the International Affective Picture System (subjective experience of emotion) and the Symptom Checklist 90 Revised (psychopathology) were employed. The CG group showed lower scores on the dimension of valence for specific conditions on the IAPS, related to the subjective experience of emotion. In addition, they presented higher values of psychopathology. In contrast, statistically significant results were not found for the recognition of emotion. In conclusion, from a neuropsychological point of view, the subjective aspects of emotion and psychopathology seem central in explaining the experience of those with CG. These results are clinically significant for psychotherapists and psychoanalysts working in the field of grief and loss.

Increased Amygdala Activations during the Emotional Experience of Death-Related Pictures in Complicated Grief: An fMRI Study

“…Death-related pictures evoked cortical activations in both groups, but they were more intense among those with CG. More research is needed to clarify the role of pleasurable or positive stimuli in relation to grief; however, these results are consistent with previous findings on emotional decision-making with reinforcers [54,55] and on the difficulties associated with processing positive emotions [6,8,9].…”

“…The CG group showed greater activation of these areas while processing death-related versus positive pictures, whereas the NB group show a similar brain pattern across conditions. This result might indicate a difference in the processing by individuals with CG between positive or pleasant emotional stimuli and death-related stimuli [6,9,16]. Although previous investigations have shown a greater activation of the reward system while viewing pictures of the deceased person [19], the present results suggest that this system is inversely altered while processing positive/pleasant affective stimuli.…”

“…CG has been associated with a lesser expressiveness of emotions [6], difficulties in the flexible regulation of emotions [7,8], a subjective emotional experience pattern of more unpleasant feelings [9], and a distinct processing of stimuli with a strong emotional component or directly associated with the loss of a loved one. In this regard, studies on approach-avoidance responses to reminders of the loss found that individuals with CG respond more slowly when faced with death-related words [10,11] and take longer to avoid images associated with death or loss [12].…”

“…Furthermore, the response to affective autobiographical stimuli related to the deceased person is frequently compared with the response to a neutral condition alone (e.g., [18,19,23]). Although exposure to this type of material appears to increase emotional reactivity [24], behavioral studies have also observed emotional alterations in response to other types of pleasant or unpleasant stimuli in individuals with CG [6,9,16]. It is therefore of interest to identify neural correlates of emotional processing by individuals with CG in response to other stimuli besides those related to their loss, using emotional pictures with different valence and arousal ratings [25][26][27].…”

“…A secondary objective was to explore the interaction between the brain activation evoked by each type of picture and group membership and its association with measures of grief intensity. There were two study hypotheses: (1) In comparison to the NB group, the CG group would show greater activation in the amygdala, in frontal areas, and in areas associated with the reward circuit when viewing death-related pictures, based on studies by Arizmendi et al [21], Freed et al [17] and O'Connor et al [19]; and (2) the CG group would show less activation in areas associated with the processing of pleasant stimuli (limbic and subcortical areas) when viewing positive pictures, with a significant interaction of group with this type of image and death-related pictures, based on studies by Diminich & Bonanno [6] and Fernández-Alcántara et al [9].…”