Interpersonal expectations in Major Depressive Disorder: Examining the impact of day-to-day negative interpersonal expectations on momentary depressive symptoms and long-term symptom trajectories

大约50%的严重抑郁障碍(MDD)患者在五年内复发(缓解后恢复症状)或复发(恢复后新发作)。为了提高对复发的预测，我们需要关于抑郁症状形成、维持和重新出现的潜在过程的经验性理论模型。最近在理解与MDD相关的认知过程方面的进展表明，当面对纠正积极的经验时，消极期望及其‘免疫力’(即，坚持性)可能是一种主要的潜在机制(“ViolEx”模型)。基本假设是，抑郁症状的出现是由于对特定情况(例如，任务绩效)的负面预期升高，而这些负面预期仍然不受积极预期违规(例如，出人意料的良好表现)的影响。关于绩效期望的相关和实验研究支持这一模型，但到目前为止，人际领域的期望很少受到关注。考虑到MDD是一种固有的社交障碍，其特征是社交快感缺失、社交技能缺陷以及对社交排斥的敏感性增加，这种研究的匮乏是令人震惊的。鉴于人际过程在MDD中的重要性，对MDD患者日常生活中关于人际互动的主观期望进行纵向检查，以了解抑郁症状的出现和持续，似乎是有希望的。负面人际期望是一种有趣的候选机制，因为它们将成熟的ViolEx模型应用于现实世界中主观上有意义的人际互动。我们将使用体验抽样法(ESM)进行一项研究，该方法允许在现场检验对人际互动的期望，具有较高的生态效度。具体地说，我们建立在前瞻性ESM的基础上，这是一种我们在初步研究中评估的方法。在未来的ESM中，我们要求参与者预测一天中即将到来的互动，并报告他们的人际期望。这一前瞻性评估稍后可以与一天中发生的实际人际互动进行比较，使我们能够将预期的负面与经验(即，违反预期)进行比较，并检查负面预期随着时间的推移的稳定性。对人际情境的评估将在霍普伍德、平卡斯、赖特等人的当代整合人际理论(CIIT)的框架内进行操作。我们将比较MDD患者、非临床对照患者和焦虑症患者之间的人际期望，以评估效果的特异性。此外，我们将研究日常生活中的人际期望是否与MDD患者6个月的抑郁症状轨迹有关，以提高我们对导致复发和复发的预测因素的理解。

Approximately 50% of people with Major Depressive Disorder (MDD) experience a relapse (returning symptoms after remission) or a recurrence (a new episode after recovery) within five years. To improve the prediction of relapse, we need empirically supported theoretical models on processes underlying the formation, maintenance, and re-emergence of depressive symptoms. Recent advances in the understanding of cognitive processes associated with MDD suggest that negative expectations and their ‘immunity’ (i.e., persistence) when faced with correcting positive experiences could be a central underlying mechanism (“ViolEx” model). The basic assumption is that depressive symptoms emerge due to elevated negative expectations regarding specific situations (e.g., task performance), which remain unaffected by positive expectation violations (e.g., an unexpectedly good performance). Correlational and experimental studies on performance expectations support the model but expectations in the interpersonal domain have received very little attention so far. This paucity of research is striking given that MDD is an inherently social disorder characterized by social anhedonia, social skill deficits, and increased sensitivity to social rejection. Given the importance of interpersonal processes in MDD, it seems promising to examine subjective expectations about interpersonal interactions longitudinally in the daily lives of people with MDD to understand the emergence and persistence of depressive symptoms. Negative interpersonal expectations are an intriguing candidate mechanism because they apply the well-established ViolEx model to subjectively meaningful interpersonal interactions in the real world. We will conduct a study using the Experience Sampling Method (ESM), which allows to examine expectations about interpersonal interactions in situ with high ecological validity. Specifically, we build upon prospective ESM, a method which we evaluated in a pilot study. In prospective ESM, we ask participants to anticipate upcoming interactions during the day and to report their interpersonal expectations. This prospective assessment can later be compared to actual interpersonal interactions occurring during the day, allowing us to compare the negativity of expectations with experiences (i.e., expectation violations) and to examine the stability of negative expectations over time. Assessments of interpersonal situations will be operationalized within the framework of contemporary integrative interpersonal theory (CIIT) by Hopwood, Pincus, Wright et al. We will compare interpersonal expectations between people with MDD, non-clinical controls, and people with anxiety disorders to assess the specificity of the effect. Further, we will examine whether everyday life interpersonal expectations are associated with 6-month depressive symptom trajectories in people with MDD to improve our understanding of the predictors contributing to relapses and recurrences.