Inflexibility as a Vulnerability to Depression: A Systematic Qualitative Review

Abstract

The study of vulnerabilities to depression typically identifies factors that are thought to be universally maladaptive or adaptive. In contrast, researchers recently have theorized that the ability to flexibly engage in different thoughts and behaviors that fit situational demands may be most indicative of psychological health. We review empirical evidence from 147 studies reporting associations between five components of flexibility (set-shifting, affective set-shifting, cardiac vagal control, explanatory flexibility, and coping flexibility) and depression and classify studies according to strength of study design. Evidence from correlational and case-controlled studies suggests cross-sectional relationships, but few prospective studies have been conducted. We discuss limitations of existing studies, identify new directions for programmatic research, and discuss implications that flexibility has for the prevention and treatment of depression.

Perseverate or decenter? Differential effects of metacognition on the relationship between parasympathetic inflexibility and symptoms of depression in a multi-wave study

“…Lacking the ability to decenter in the context of the other risk factors might mean that individuals have difficulty stepping back and disengaging from PC, which, in conjunction with parasympathetic inflexibility may make them less able to adapt to a variety of situations. This could lead individuals to miss important contextual information (e.g., awareness of one’s negative affect, that a current regulatory strategy has not been effective, or of opportunities for reward in the environment) that might signal that a change would be useful (e.g., Aldao, Sheppes, & Gross, 2015; Bonanno & Burton, 2013; Cheng, 2001; Gross, 2015; Kato, 2012; Stange et al, in press). …”

“…Given these debilitating effects, research has aimed to identify possible mechanisms and risk factors for MDD that might serve as targets for prevention or treatment (Alloy et al, 2017). Broadly, MDD is associated with a loss of biological and behavioral flexibility (Kashdan & Rottenberg, 2010; Stange, Alloy, & Fresco, in press). Specifically, MDD is characterized by inflexible physiological responses (Bylsma, Salomon, Taylor-Clift, Morris, & Rottenberg, 2014), difficulty disengaging from perseverative thinking processes such as rumination, and with mentally distancing oneself from one’s negative thinking (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Fresco et al, 2007a; Bernstein et al, 2015).…”

“…Specifically, MDD is characterized by inflexible physiological responses (Bylsma, Salomon, Taylor-Clift, Morris, & Rottenberg, 2014), difficulty disengaging from perseverative thinking processes such as rumination, and with mentally distancing oneself from one’s negative thinking (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Fresco et al, 2007a; Bernstein et al, 2015). Furthermore, healthy individuals who are inflexible in response to changes in environmental or emotional context also may be susceptible to developing depression (Stange et al, in press). However, not all individuals who are inflexible in one domain necessarily develop depression, suggesting that the identification of risk factors in isolation may be an overly simplistic representation of risk.…”

“…Indeed, extensive literature has documented that lower levels of RSA at rest are associated with maladaptive emotion regulation and MDD (Kemp et al, 2010; Rottenberg, 2007). However, recent work has suggested that RSA reactivity (vagal withdrawal) in response to sadness might be an index of regulatory flexibility that is particularly relevant to understanding depression and depression risk (for recent reviews, see Hamilton & Alloy, 2016; Stange et al, in press). Indeed, MDD appears to be characterized by a lack of RSA reactivity in response to sadness (Bylsma et al, 2014; Rottenberg, Clift, Bolden, & Salomon, 2007a), and individuals who have lower RSA reactivity (or vagal withdrawal) may be at risk for the onset of symptoms of depression and a poorer course of MDD (Panaite et al, 2016; Rottenberg et al, 2005; Stange et al, 2017).…”

“…However, few such prospective studies have been conducted to evaluate the extent to which low RSA reactivity confers risk for future depression. Furthermore, beyond identifying parasympathetic inflexibility as a general risk factor, there is a need to identify contexts – such as other known risk factors – which could work synergistically with the parasympathetic nervous system in risk for depression (e.g., Aldao, 2013; Stange et al, in press). …”